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

No abstract available.
Down Syndrome* ; Myeloproliferative Disorders*

No abstract available.
Pregnancy*

BACKGROUND: Pancreatoduodenectomy is a standard operation for benign and malignant lesions of the periampullary area. Even though the complication and the mortality rates have markedly decreased owing to recent developments in surgical techniques and postoperative care, the complication rates still remain high. Especially, pancreatic leakage is the main cause of death today in a pancreatoduodenectomy, so surgical techniques dealing with this problem have emerged as a major issue. The usual techniques used have been the duct ligation method, the duct occlusion method, a pancreatojejunostomy, and a pancreatogastrostomy. However, a recent trend has been to maintain pancreato-enteric continuity. Thus, the authors used a pancreatojejunostomy with the duct-to-mucosa method to decrease the complications. METHODS: The authors retrospectively reviewed the medical records of 56 patients who had undergone a pancreatoduodenectomy between January 1987 and July 1997 by one surgeon. RESULTS: The male-to-female ratio was 1.4:1 and the mean age was 55.5 years (ranging from 25 to 77). A Whipple's operation was done in 44 cases, and a pylorus-preserving pancreatoduodenectomy was done in 12 cases. All the cases used a pancreatojejunostomy with the duct-to-mucosa method. No pancreatic leakage was observed in any of the 56 cases. The immediate postoperative complication rate was 28.6%, and there was one (1.8%) postoperative mortality due to adult respiratory distress syndrome. Six patients complained of minimal exocrine functional abnormality, but only one patient, who had suffered severe chronic pancreatitis preoperatively, routinely now takes a pancreatic enzyme. However, even after long-term follow up, no endocrine insufficiency has been detected. CONCLUSIONS: Through our experience, a pancreatojejunostomy with the duct-to-mucosa method is a secure and reasonable method and can be used for all patients undergoing a pancreatoduodenectomy.
Cause of Death ; Follow-Up Studies ; Humans ; Ligation ; Medical Records ; Mortality ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Postoperative Care ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

No abstract available.
Brain Neoplasms* ; Brain* ; Cell Line* ; Immunotoxins*

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; Child ; Child, Preschool* ; Depression ; Enflurane* ; Halothane* ; Humans ; Infant* ; Linear Models ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Ulnar Nerve

Most patients who have spondylolysis dont's need surgical treatment. However, for the patients who have no response to conservative treatment, surgical treatment may be indicated. In 1970, Buck reported the operative technique that the used two screws between the pars defect and lamina followed by bone graft. In patients who have spondyloysis, pain in the back seems to be due to instability and irritation of nerve root by the abnormal motion of the loose neural arch and granulation tissue. For period of 7 years from May, 1984 to March, 1991, twelve patients with spondyloysis who had no response to conservative treatment were treated with Buck's operation and were analyzed. Following results were obtained: 1. The age of the patients was 24 years in average ranging from 14 to 40 years. 2. The level of the lesion was L5 in 10 cases, L4 in 2 cases. 3. Preoperative clinical feature included low back pain in 12 cases, refered pain in 2 cases. 4. Clinical sympotoms were improved in 83%, and the follow up result of the operation: excellent 16.7%, good 66.6% and poor 16.7%.
Follow-Up Studies ; Granulation Tissue ; Humans ; Low Back Pain ; Spondylolysis ; Transplants

OBJECTIVE: This study investigated whether pyrosequencing can be used to determine the methylation status of the MGMT promoter as a clinical biomarker using relatively old archival tissue samples of glioblastoma. We also examined other prognostic factors for survival of glioblastoma patients. METHODS: The available study set included formalin-fixed paraffin-embedded (FFPE) tissue from 104 patients at two institutes from 1997 to 2012, all of which were diagnosed histopathologically as glioblastoma. Clinicopathologic data were collected by review of medical records. For pyrosequencing analysis, the PyroMark Q96 CpG MGMT kit (Qiagen, Hilden, Germany) was used to detect the level of methylation at exon 1 positions 17-39 of the MGMT gene, which contains 5 CpGs. RESULTS: Methylation of the MGMT promoter was detected in 43 (41.3%) of 104 samples. The average percentage methylation was 14.0+/-16.8% overall and 39.0+/-14.7% for methylated cases. There was no significant pattern of linear increase or decrease according to the age of the FFPE block (p=0.687). In multivariate analysis, age, performance status, extent of surgery, method of adjuvant therapy, and methylation status estimated by pyrosequencing were independently associated with overall survival. Additionally, patients with a high level of methylation survived longer than those with low methylation (p=0.016). CONCLUSION: In this study, the status and extent of methylation of the MGMT promoter analyzed by pyrosequencing were associated with overall survival in glioblastoma patients. Pyrosequencing is a quantitative method that overcomes the problems of MSP and a simple technique for accurate analysis of DNA sequences.
Academies and Institutes ; Base Sequence ; Exons ; Glioblastoma* ; Humans ; Medical Records ; Methylation* ; Multivariate Analysis ; Prognosis

The anterior communicating artery is one of common sites of intracranial aneurysms, and the anterior communicating artery aneurysms are operated by pterional approach most commonly. Anatomical variation around anterior communicating artery is one of the limiting factors in surgery. Pterional approach can be made from either left or right side according to many factors, such as, dominant feeding artery, shape, size and direction of aneurysm, vascular anomaly and variation around anterior communicating artery, existence of hematoma, and multiple aneurysms. Authors analyzed 62 cases of anterior communicating artery aneurysm and discussed optimal surgical direction in pterional approach and evaluated the usefulness of position of bilateral A1-A2 junction in lateral compression angiogram. The results were as follows: 1) In the existence of another aneurysm in the carotid or middle cerebral artery, optimal surgical direction is to the side of another aneurysm. 2) Significant amount of hematoma should be considered in selecting the surgical direction. 3) If the aneurysm is large, thrombosed, and fundus is broad, the approach should be made to the side which facilitate the exposure of the neck of aneurysm first. 4) Right side approach has advantages that nondominant hemisphere is retracted and surgical manipulation is convenient with small craniotomy. 5) Exposure of the neck of the aneurysm and temporary clip is easier when approach is made along the main feeding artery. 6) Approach to the side of posteriorly placed A1-A2 junction can be another useful option in selecting optimal surgical direction.
Aneurysm ; Arteries ; Craniotomy ; Hematoma ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Neck

The effect of indomethacin on Na-K-ATPase and K-pNPPase activity was studied with rat brain homogenate. The results were as follows : 1) Indomethacin inhibited both Na-K-ATPase and K-pNPPase in a dose-related pattern. 2) Inhibition mode of indomethacin for K+ in both Na-K-ATPase and K-pNPPase was competitive type. 3) Indomethacin showed stimulative effect at lower sodium concentration below 10mM, and showed inhibitory effect at higher sodium concentration on Na-K-ATPase and K-pNPPase activity, and the inhibitory effect was slightly increased with increasing concentration of sodium. 4) The inhibitory effect of indomethacin on Na-K-ATPase activity was increased with increasing ATP concentration, but was not affected by Mg++ concentration. These results indicate that indomethacin inhibits Na-K-ATPase activity by inhibiting K+- dependent dephosphorylation steps.
Adenosine Triphosphate ; Animals ; Brain* ; Indomethacin* ; Rats* ; Sodium