This paper reports our experiences in laparoscopically assisted surgical staging (LASS) to manage the patients with early-stage endometrial cancer. From March 1996 to March 1999, we performed LASS in 6 patients with clincal stage I adenocarcinoma of the endometrium. We performed laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the grade of the tumor and depth of myometrial invasion. One patient was discovered to have tumor metastases in pelvic peritoneum and uterosacral ligaments, and underwent only para-aortic lymphadenectomy for determining field of radiation therapy. 2 out of 5 patients only underwent LAVH with BSO and peroitoneal washing cytology. Three other patients underwent LAVH with BSO, peritoneal washing cytology and pelvic lymphadenectomy because they were identified by IFS diagnosis as intermediate risk group for nodal metastasis. The mean age of the patients was 46.4 years. Total length of the operation time ranged from 100 minutes to 305 minutes and the mean was 187.5 minutes. The mean hemoglobin decrement after the surgery was 0.9 gm/dl. No one recieved blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 16.7 and 18, respectively. After the surgery, the patients passed gas after an average of 2.0 days and urinated urine after an average of 3.8 days. No one had complication after LASS. Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.
Adenocarcinoma ; Blood Transfusion ; Diagnosis ; Endometrial Neoplasms* ; Endometrium ; Female ; Humans ; Hysterectomy, Vaginal ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Peritoneum

Cardiac catheterization has been used as an essential diagnostic procedure since 1929 when initiated by Forssman. Anesthesis in an infant will change BP and respiration and thus the diagnostic results may be effected. It is desirable to minimize these effects and still give safe anesthesia. To solve these problems some authors have recently reported on the use of ketamine for anesthesia. Ketamine has simple and rapid induction, easy maintanance of airway and respiration without intubation or extra oxygen supply (Stanley et al, 1969, Coppel and Dundee, 1972). But it causes a rise of BP and pulse rate(Domino et al 1965: Roberts, 1967: Phillips et al, 1970) which may effect the results of catheterization. In the present clinical study to evaluate the effect of ketamine on BP, pulse and pulmonary artery pressure, 47 congenital heart cases were randomly divided into 2 groups. In group l the effect of ketamine on BP EKG and respiration was studied on 37 patients undergoing cardiac catheterization and angilgram. The average age was 4 years with a range from 1/2 to 13 years, and the weight averaged 14kg with a range from 6 to 40kg. In group 2, a cathether was inserted into the main pulmonary artery under local anesthesia and the pressure was measured before and after l.V. ketamine (1mg/kg) in 10 cases in which the age was around 7years(range 3~13 years) and the body weight around 19kg(range 11~32kg). The following results were obtained: 1. Mean blood pressure significantly increased from 82.7+/-1.8mmHg to 91.8+/-2.0mmHg in 1 min. after l.V. ketamine and lasted around 4min. The pulse rate increased from 125.9+/-4.1min. to 131.9+/-4.3min in 1 min. after ketamine and lasted about 2 min. 2. Immediately after angiogram the blood pressure significantly decreased from 111.7+/-2.8/70.0+/-2.3mmHg to 88.0+/-2.4/51.6+/-2.4mmHg in group l. 3. The amin pulmonary artery pressure increased significantly form 41.9+/-7.16/16.4+/-4.8mmHg to 50.8+/-8.7/23.7+/-5.8mmHg. The mean pulmonary artery pressure difference was 8.1+/-0.9mmHg after ketamin I.V. injection and the mean aorta pressure difference at the time was 11.2+/-2.2mmHg in group 2. 4. No. other findings were observed. From the above results, although ketamine obviously raised pulmonary artery pressure and blood pressure during cardiac catheterization, there was no intereference in diagnosing the condition. It suggests that the use of ketamin is a safe method when cardiac catheterisation is performed in children with cardiac problems except when there is severe pulmonary hypertension.
Anesthesia* ; Anesthesia, Local ; Aorta ; Blood Pressure ; Body Weight ; Cardiac Catheterization* ; Cardiac Catheters* ; Catheterization ; Catheters ; Child ; Electrocardiography ; Heart ; Heart Rate ; Humans ; Hypertension, Pulmonary ; Infant ; Intubation ; Ketamine* ; Oxygen ; Pulmonary Artery ; Respiration

We compared all frozen section examination of ovarian tumors during a 5 year period in our institute with permanent section diagnosis from paraffin sections. In this period, 604 ovarian tumors had frozen section examination. Final histologic diagnosis was divided into benign, low malignant potential and malignant. Sensitivity of frozen section diagnosis for malignant was 80 %, low malignant potential 73,1%, and benign 99.8%. Predictive value for malignancy was 98.5%, for low malignant potential 76.6%, and for benign disease 96.2%. Diagnostic problems occurred in huge tumors and low malignat potential mucinous tumors. Analysis of the 32 false negative(miss or under diagnosis) revealed that a sampling error was involved almostly. The cases of discrepancy between frozen section diagnosis and permanent section diagnosis, were 26/34 in mucinous tumors and 33/34 in huge size of tumors(more than 10cm). Although surgeons and pathologist are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under or over treatment of ovarian malignancies.
Diagnosis* ; Frozen Sections* ; Mucins ; Paraffin ; Selection Bias

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.
Competitive Bidding ; Employment ; Food Service, Hospital* ; Food Services ; Gyeonggi-do ; Humans ; Incheon ; Investments ; Meals ; Organization and Administration ; Personnel Management ; Postal Service ; Surveys and Questionnaires ; Seoul

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.
Competitive Bidding ; Employment ; Food Service, Hospital* ; Food Services ; Gyeonggi-do ; Humans ; Incheon ; Investments ; Meals ; Organization and Administration ; Personnel Management ; Postal Service ; Surveys and Questionnaires ; Seoul

OBJECTIVE: Nitric oxide has a short half-life and is easily oxidized by nitrite, we can indirectly find out its activity by measuring the nitric oxide synthase in cells. The purpose of this study is to confirm the differences in the expression modes of eNOS in uterine endometrium and myometrium between the patients of uterine leiomyoma and the control group. METHODS: We defined the patient group as perimenopausal women who were diagnosed with uterine leiomyoma and underwent total hysterectomy, and the control group as the women who had no lesions in uterus. All of them were classified into proliferative phase and secretory phase by the Noyes standards and compared by immunohistochemical stain for eNOS. RESULTS: There is no significant differences between the patients of uterine leiomyoma and the control group statistically (endometrium P=0.319, myometrium P=0.264). The expression of eNOS in the vascular endothelial cells of the endometrium did not show significant differences statistically by menstrual cycle (proliferative phage P=0.549, secretory phage P=0.240). The expression of eNOS in the myometrium also did not show significant differences by menstrual cycle or by group statistically (proliferative phage P=0.279, secretory phage P=0.224). CONCLUSIONS: In this study, the expression of endothelial nitric oxide synthase was higher in the patients of uterine leiomyoma than in the control group, and during the secretory phase in menstrual period, but there was no statistical significance. We suppose that we can get statistically significant results if we have many cases of subjects.
Animals ; Bacteriophages ; Endometrium ; Endothelial Cells ; Female ; Half-Life ; Humans ; Hysterectomy ; Leiomyoma ; Menstrual Cycle ; Mice ; Myometrium ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type III ; Uterus

OBJECTIVES: To estimate false-negative rate of cervical smears using Autopap 300 QC system in rescreening modality. METHODS: From September 1997 to December 1997, Total 26,983 cervical smears were obtained and 18,592 cervical smears were rescreened by Autopap 300 QC system with 10% review rate. The 274 cases of total 26,983 cervieal smears were confirmed histologically by colposcopic biopsy, cone biopsy and hysterectomy. The 274 cases of cervical smears, which obtained prior to pathologic diagnosis made, were evaluated based on cyto-histologic correlation and then the false negative rate were estimated. The cervical smears were reviewed, researching for the cause of false negative. RESULTS: (1) Histologic diagnosis of 274 cases include 65 cases of Low SIL, 173 cases of High SIL, 29 cases of SCC, 2 cases of adenocarcinoma in situ, and 5 cases of invasive adenocarcinoma. (2) The false negative rate were 3% (9/274). Those were 6.2%(4/65) of LSIL, 2.3% (4/173) Of HSIL, none of SCC and AIS, and 20%(5/1) of invasive adenocarcinoma. (3) The false negative cases were reviewed. The 6 cases were sampling enor and 3 cases were screening error. CONCLUSION: Using AutoPap 300 QC system in rescreening modality, The false negative rate of cervical smears were decreased, compared with our previous study.
Adenocarcinoma ; Biopsy ; Diagnosis ; Hysterectomy ; Mass Screening ; Vaginal Smears

Apoptosis, including the programmed cell death, is important event in normal cell turnover and maintenance of adult tissues. Apoptosis exerts a homeostatic function in relation to tissues dynamics, as the steady state of continuously renewing tissues achieved by a balance between cell replication and cell death. This study was undertaken to investigate the association between apoptosis and development of the cervical neoplasia. Archival cervical samples from normal epithelium (n 10), low-grade squamous intraepithelial lesions (LSIL, n = 10), high-grade squamous intraepithelial lesions (HSIL, n 10), microinvasive squamous cell carcinomas (n 10), and invasive squamous cell carcinomas (n = 10) were evaluated for apoptosis. We used in situ end-labeling of DNA strand breaks by terminal deoxynucleotidyltransferase incorporation of biotinylated deoxyuridine to 3-OH ends of DNA, identified by nickel-avidine-peroxidase. The apoptotic index (sum of apoptotic bodies divided by the total nuclei times 100) significantly decreased (P<0.05) as the degree of neoplasia increased: 3.1 + 0.9 % in normal epithelium, 5.5 +/- 1.4 % in LSIL, 1.6 +/- 0.4 % in HSIL, 1.9 +/- 0.5 % in microinvasive carcinomas, and 0.6 +/- 0.3 % in invasive carcinomas. Compared to normal epithelium, the total cell number per 200x field increased significantly (P<0,05): 379 +/- 47 in normal epithelium, 462 +/- 228 in LSIL, 670+/-293 in HSIL, 1035 +/- 254 in microinvasive carcinomas, and 1389 +/- 247 in invasive carcinomas. Consequently, these results suggest that progession of cervical carcinogenesis is associated with a decrease in apoptotic index and an increase in the number of the total cell.
Adult ; Apoptosis* ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Count ; Cell Death ; Deoxyuridine ; DNA ; DNA Nucleotidylexotransferase ; Epithelium ; Humans

Comparative Genomic Hybridization (CGH) is a recently developed molecular cytogenetic technique, which makes it possible to detect chromosomal alteration in solid tumors. To determine whether chromosome alterations are related to cervical carcinoma, we have analyzed 33 cases (24 squamous cell carcinomas and 9 adenocarcinomas, stage Ib-IIIb) from tumor tissues and paraffin embedded tissues by CGH. The cut off value of CGH profiles was 1.15 and 0.85 (green/red ratio). Chromosomal aberrations were detected in 30 out of 33 cases (90.9%). In 32 cases, chromosome 3q was most frequently affected and had greater copy numbers in 20 of tbe 33 cases (60.6%). Interestingly, out of those 20 cases, 10 cases were shown to have a high-level of amplification of chr 3q. In addition to chr 3q, chromosomal gains were observed in chr 1q, 1p, 5p, Sq, 12p, 15q, 19q, 20q, Xp, and Xq. Furthermore chromosomal loss was detected, most commonly in chromosome 11q (11/33). Although less frequent, common losses were also detected in chr 2q, 4p, 4q, Sq, 1 1p, 17p, and 18p. In addition, there were cases of gross chromosome loss for chr 4, 6, 10, 11, 13, 14, 16, 17, 18, 19, 20, 21, 22 and X. In cases involving whole arm deletion, we utilized fluorescence in situ hybridization (FISH) using specific probes a-satellite. We performed HPV typing for 16 and 18 usiag polymerase chain reaction (PCR) and Southem blot analyses. Out of 33 tumor samples, 24 cases (72,7%) were HPV 16 positive, while only 6 cases were positive for HPV 18. two cases were positive for both HPV 16 and 18. We believe that a gain of chromosome 3q as a reeurrent chromosomal aberration may contribute to the tumorigenesis of cervical cancer. However, we could not correlate a pattern of chromosomal aberration with tumor stage or histologic type in cervical cancer.
Adenocarcinoma ; Arm ; Carcinogenesis ; Carcinoma, Squamous Cell ; Chromosome Aberrations ; Comparative Genomic Hybridization* ; Cytogenetic Analysis ; Fluorescence ; Human papillomavirus 16 ; Human papillomavirus 18 ; In Situ Hybridization ; Paraffin ; Polymerase Chain Reaction ; Uterine Cervical Neoplasms

Actinomyces species are gram-positive, non-acid fast anaerobic bacteria that exhibit branching, filamentous growth. More recently, It reported that female genital actinomycosis has been associated with the use of an intrauterine contraceptive device (IUD). We have experienced a case of pelvic and abdominal wall actinomycosis with mucinous cystadenoma in a 36-years-old woman using IUD and report it with brief review of literature.
Abdominal Wall* ; Actinomyces ; Actinomycosis* ; Bacteria, Anaerobic ; Cystadenoma, Mucinous ; Female ; Humans ; Intrauterine Devices