Measurement of the serum CA 125 level as a tumor marker in patients with epithelial ovarian cancer has been widely used to monitor disease status and predict survival of patient. While a number of benign gynecologic as well as benign or malignant non-gynecologic conditions are associated with elevations of serum CA 125 levels, the established normal range describes a healthy population of women. Because the metabolism and clearance of CA 125 is not well understood and mild or moderate degrees of renal impairment frequently occurs in ovarian cancer patients during treatment or course of disease, it is valuable to investigate the effect of impaired renal function on serum level of CA 125. Eighty-nine women on hemodialysis who had no other definite cause to elevate serum CA 125 level were selected at random. The age of the patients ranged from 19 to 83 and renal disease was secondary in most cases to diabetes mellitus, hypertension or glomeru-lonephritis. The creatinine clearance was less than 10cc/min for all patients. (continue)
Creatinine ; Diabetes Mellitus ; Female ; Humans ; Hypertension ; Metabolism ; Ovarian Neoplasms ; Reference Values ; Renal Dialysis

PURPOSE: Multiple methods are used to diagnose acute appendicitis. However, with the current practice, the negative laparotomy rate for acute appendicitis is from 15% up to 30%. This study was designed to evaluate various pathologies of the appendix and other intraabdominal organs of patients preoperatively diagnosed with acute appendicitis and to analyze clinically the difference between acute appendicitis and other intraabdominal inflammatory diseases. METHODS: We reviewed the pathologic reports of 833 patients who underwent laparotomies for acute appendicitis from January 1997 to December 2001. We grouped these patients by pathology. Group I included patients with a negative appendectomy and no other intraabdominal pathology, group II included those with lesions within the appendix, and group III, those with intraabdominal lesions other than in the appendix. We also analyzed the age, sex distributions, the typical symptoms of appendicitis, the duration of symptoms, fever, and leukocytosis of 100 patients with typical appendicitis by random sampling to find the clinical differences that existed between pelvic inflammatory disease and cecal diverticular disease presented as appendicitis. RESULTS: The diagnostic accuracy for acute appendicitis was 79.7%, and the negative appendectomy and negative laparotomy rates were 17.4% and 15.5%, respectively. The percents of patients in group I, II, and III were 10.4%, 82.6%, and 7.0%, respectively. CONCLUSIONS: It is important to consider the possibility of various pathologies during diagnostic and operative procedures for an acute abdomen, especially one occurring in the right lower quadrant.
Abdomen, Acute ; Appendectomy ; Appendicitis* ; Appendix ; Diagnosis, Differential* ; Female ; Fever ; Humans ; Laparotomy ; Leukocytosis ; Pathology* ; Pelvic Inflammatory Disease ; Sex Distribution ; Surgical Procedures, Operative

Purpose: This paper proposes a technological system that uses artificial intelligence to recognize and guide the operator to the exact stenosis area during endoscopic surgery in patients with urethral or ureteral strictures. The aim of this technological solution was to increase surgical efficiency. Methods: The proposed system utilizes the ResNet-50 algorithm, an artificial intelligence technology, and analyzes images entering the endoscope during surgery to detect the stenosis location accurately and provide intraoperative clinical assistance. The ResNet-50 algorithm was chosen to facilitate accurate detection of the stenosis site. Results: The high recognition accuracy of the system was confirmed by an average final sensitivity value of 0.96. Since sensitivity is a measure of the probability of a true-positive test, this finding confirms that the system provided accurate guidance to the stenosis area when used for support in actual surgery. Conclusions The proposed method supports surgery for patients with urethral or ureteral strictures by applying the ResNet-50 algorithm. The system analyzes images entering the endoscope during surgery and accurately detects stenosis, thereby assisting in surgery. In future research, we intend to provide both conservative and flexible boundaries of the strictures.

Mutations in the tumor suppressor p53 gene are the most frequently observed genetic lesions in human cancers. It seems that wild type p53 does significant role on growth and differentiation of normal cells, Mutations and allelic loss of the p53 gene are thought to be a cause of tumor development and to be correlated with the prognostic factors in various human cancers such as breast, ovary and lung cancer. Mutant p53 proteins have a prolonged half-life and can be detected by immunohistochemistry. In case of GTD(gestational trophoblastic disease), although the mutation of p53 gene mutation was revealed to be very rare, the overexpression of p53 in immunohistochemical staining has been reported in wide range of discrepancy and its role or prognostic significance in GTD is uncertain. This study is performed to define the status of p53 overexpression in GTD and to evaluate the correlations between p53 overexpression and prognostic factors of GTD. THE RESULTS WERE AS FOLLOWS: 1. p53 overexpression was detected in none of normal placental tissue, in 58.3%(14/24) of hydatidiform mole, in 15%(6/8) of invasive mole, in 75%(3/4) of choriocarcinoma, and in 100%(1/1) of placental site trophoblastic tumor, and showed significant difference between normal placenta and GTD. We could not find any difference of the p53 overexpression between benign group(H-mole) of GTD and malignant one(invasive mole, choriocarcinoma, and placental site trophoblastic tumor) 2. In H-mole, low-risk group showed significantly higher prevalence of p53 overexpression than high-risk group did. In malignant group, there is no difference in the prevalence of p53 overexpression between early(FIGO stage I) and late(II- IV)stage-diseases, but the prevalence of p53 overexpression of low-risk group is slightly higher than that of high-risk group although we failed to find statistical significance. In conclusion, the high prevalence of p53 overexpression in GTD suggests that p53 may have a certain role in the pathogenesis of GTD or at least represent generalized DNA damage or genetic instability of GTD. And the higher prevalence of p53 overexpression in low-risk group suggests that accumulation of wild-type p53 may be related with favorable prognosis in GTD.
Breast ; Choriocarcinoma ; DNA Damage ; Female ; Genes, p53 ; Gestational Trophoblastic Disease* ; Half-Life ; Humans* ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Immunohistochemistry ; Loss of Heterozygosity ; Lung Neoplasms ; Ovary ; Placenta* ; Pregnancy ; Prevalence ; Prognosis ; Trophoblastic Tumor, Placental Site ; Trophoblasts

No abstract available.
Carcinoma, Transitional Cell* ; Fallopian Tubes* ; Female

Tumor DNA content measured by flow cytometry may be a predictor in the prognosis of epithelial ovarian cancer, but the results have been inconsistent. It is recognized that these conflicting results are at least partly due to the variation of DNA content between the samples from the same patient(i.e., intratumoral DNA heterogeneity). The purposes of this retrospective study were to investigate the frequency and the nature of DNA heterogeneity in epithelial ovarian cancer and to evaluate the prognostic significance of DNA heterogenetiy itself. Thirty-two patients with stage II to IV epithelial ovarian cancer who were managed at Asan Medical Center between May 1993 and April 1996 were analysed. Measurements of the nuclear DNA content were performed on samples from primary and metastatic lesion using paraffin embedded archival tissues by Epics(Coulter Inc.) flow cytometry. In two cases, the metastatic tumor was minute and did not reveal a separable peak on repeated examination. DNA heterogeneity was defined as different ploidy pattern or difference of the DNA indices than 0.15 between primary and metastatic tumors. DNA heterogeneity was found in 11 cases(36.7%), and the number of cases with homogeneous diploid and that with homogeneous aneuploid tumor were 5(16.7%) and 14(46.7%) respectively. In evaluation of prognostic significance of DNA heterogeneity using correlation with serum CA 125 level after second course of chemotherapy and residual tumor size after cytoreductive surgery among these three groups, the patients with DNA heterogeneity were considered to show intermediate prognosis between those with homogeneous diploid and homogeneous aneuploid tumor. In conclusion, DNA heterogeneity in epithelial ovarian cancer is considerable in frequency and may have prognostic value.
Aneuploidy ; Chungcheongnam-do ; Diploidy ; DNA* ; Drug Therapy ; Flow Cytometry ; Humans ; Neoplasm, Residual ; Ovarian Neoplasms* ; Paraffin ; Ploidies* ; Population Characteristics* ; Prognosis ; Retrospective Studies

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new surgical option using endoscopic advancement to the peritoneal cavity through the stomach, colon, vagina, or urinary bladder without an abdominal wall scar (incision). The aim of this study was to assess the feasibility of transgastric gastroscopic intra-abdominal exploration with gastric incision and closure before the NOTES would be done. METHODS: Under general anesthesia of a female dog, one-channel gastroscope was advanced to the stomach and the lumen was irrigated with anti-bacterial solution. The anterior wall of the antrum was incised by about 1 cm with a needle knife; then, the gastroscope was advanced into the peritoneal cavity. An exploration of the entire intra-abdominal cavity was performed. RESULTS: We were able to evaluate the stomach, the greater omentum, the diaphragm, the peritoneum, the urinary bladder, the bowel, the spleen, the liver, the gallbladder, the uterine horn, the uterine body, and the vagina, but could not evaluate the ovary, the kidney, and the pancreas. The observation of the abdominal cavity was followed by the gastric wall closure with a 135o endoclip. The dog was recovered after confirmation of secure closure of the incision site. CONCLUSIONS: Transgastric incision, closure, and abdominal exploration are feasible without an abdominal wall scar, and the NOTES can be one option for future abdominal operations in humans and needs to be further investigated.
Abdominal Cavity ; Abdominal Wall ; Anesthesia, General ; Animals ; Cicatrix ; Colon ; Diaphragm ; Dogs* ; Female* ; Gallbladder ; Gastroscopes ; Horns ; Humans ; Kidney ; Liver ; Natural Orifice Endoscopic Surgery ; Needles ; Omentum ; Ovary ; Pancreas ; Peritoneal Cavity ; Peritoneum ; Spleen ; Stomach ; Urinary Bladder ; Vagina

Extracellular matrix component is degraded by enzymes of thematrix metalloproteinases(MMPs). MMPs are produced by both hemopoietic and structural cells. Increased activity of MMP-3 in periodontium is strongly associated with inflammatory periodontal disease. The purpose of the present study was to determine the effect of tetracycline analogues on the activity of MMP-3. Tetracycline-HCl, doxycycline-HCl, and minocycline-HCl were applied to huamn gingival fibroblasts at various concentrations of 10, 25, 50, 100, 200microgram/ml, and 1 hour later IL-1beta of 25ng/ml was added. After incubation for 24 hours the cells were reacted by enzyme-linked immunosorbent assay using proMMP-3 ELISA kit. The optical density was measured by microwell plate reader at 450nm. The relative activity of MMP-3 was calculated as the percentage of the optical density of each experimental group to that of the control. The difference of the optical density and the relative activity of MMP-3 between the experimental groups and the control wasstatistically analyzed by one way ANOVA. The results were as follows: 1. Tetracycline-HCl showed the tendency to inhibit the activity of MMP-3 at the concentration lower than 25 microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 2. Doxycycline-HCl inhibited significantly the activity of MMP-3 at the concentration lower than 100microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 3. Minocycline-HCl inhibited the activity of MMP-3 at the concentration in the range of 10 to 200microgram/ml. Within the limit of the present study, the above results suggested that the low concentration of tetracycline analogues could inhibit the activity of MMP-3 induced by IL-1beta in human gingival fibroblasts.
Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fibroblasts* ; Humans ; Interleukin-1beta ; Matrix Metalloproteinases ; Periodontal Diseases ; Periodontium ; Tetracycline*

To evaluate the maternal and fetal effects of propanidid, clinical observations were carried out in 160 cases of Cesarean section out of 4, 230 deliveries made during the past three years. Upon having the obstetricians ready for incision, 10ml. of 5 per cent propanidid and 40mg. of succinylcholine chloride were administered intravenously, and surgery was begun almost simultaneously with endotracheal intubabation. Thereafter, anesthesia was maintained with N2O-O2-fluothane, N2O-O2 -ether, or ether-O2 in semiclosed circle absorption system. Umbilical cord was ligated within 3-5 minutes after the commencement of induction. This method of anesthesia did not seriously affect the maternal respiration or circulation, and Apgar scores were good or fair in the majority of cases. No undesirable side effects or complications directly attributable to propanidid were encountered.
Absorption ; Anesthesia ; Anesthesia, General* ; Cesarean Section ; Female ; Methods ; Pregnancy ; Propanidid* ; Respiration ; Succinylcholine ; Umbilical Cord

The widely accepted method for coronary artery bypass grafting(CABG) is performing the distal coronary artery anastomoses on the flaccid and nonbeating heart with the aid of cardiopulmonary bypass(CPB) and cardioplegic arrest. However, current cardioplegic techniques are not consistent in avoiding myocardial ischemic damages especially in high risk patients undergoing CABG. In this regard, "Off-Pump" seems to be an ideal method for preventing myocardial ischemic damage and adverse effects during CPB. However, "Off-pump" CABG is not always technically feasible. We report 2 cases of "On-pump" CABG performed on the beating heart in high risk patients; The first patient had left ventricular dysfunction(Ejection Fraction=25%), and the second patient had cardiogenic shock after percutaneous transluminal coronary angioplasty.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Vessels ; Heart* ; Humans ; Shock, Cardiogenic