OBJECTIVES: Estimation of the anterior lower uterine segment (LUS) thickness difference who underwent prior cesarean delivery measured with transvaginal sonography at or after 36 gestational weeks (sonographic thickness) and a ruler during elective cesarean section (operation thickness) Methods: One hundred sixty women who underwent prior cesarean delivery had the thickness of their LUS measured with transvaginal sonography at or after 36 gestational weeks. The LUS thickness was measured with a ruler during elective cesarean section. We compared group I whose LUS was fairly well visualized 4 cm or more from the uterine cervix to group II which had less than 4 cm. RESULTS: The mean sonographic thickness of LUS was 1.7 0.8 mm and that of operation thickness was 1.9 0.5 mm. The mean difference of the two (thickness difference) was 0.5 0.5 mm. In 31.3% the sonographic thickness was same as the operation thickness and in 70.7% of the total with 0.5 mm or less difference, the sonographic thickness could be regarded as accurate. The thickness difference with the sonographic thickness with 2 mm or more was smaller than those with 1 mm or less (0.4 0.5; 0.6 0.6) and that of group I was smaller than that of group II (0.4 0.4; 0.9 0.6) (p< .05). CONCLUSION: The thickness difference was 0.5 0.5 mm and it was smaller when the LUS thickness is 2 mm or over, clearly visible 4 cm or over from the cervix.
Cervix Uteri ; Cesarean Section ; Cicatrix* ; Female ; Humans ; Pregnancy ; Ultrasonography*

We report a 12 year-old girl patient with hypothalmic hamartoma presented a gelastic seizure for 11 years. On magnetic resonance images, a 10.5 mm-sized mass was detected that was originated from the tuber cinereum into the third ventricle. This mass was isosignal intensity on T1WI, slightly high signal intensity on T2WI and not enhanced with Gadolinium. On interictal EEG, the frequent spike or polyspike dischage was recorded from the left fronto-central area. On ictal EEG, the suspicious polyspike dischages followed by spike and wave discharge were recorded from the left or both fronto-central or fronto-centro-temporal area. On 18-FDG PET (18-fluorodeoxyglucose positron emission tomography), the glucose metabolism was decresed on the mass. We treated this lesion using gamma knife radiosurgery (18 Gy at 50% margin, 508.2 mm3 volume). After 6 months, the frequency of gelastic seizure was decreased.
Child ; Electroencephalography ; Electrons ; Female ; Gadolinium ; Glucose ; Hamartoma* ; Humans ; Metabolism ; Radiosurgery* ; Seizures* ; Third Ventricle ; Tuber Cinereum

Folliculosebaceous cystic hamartoma is a distinctive skin malformation, which presents as a solitary, smooth- surfaced, skin-colored papule or nodule. This hamartoma usually occurs on the central part of the face, particularly on the nose. In 1998, Bolognia et al. described a genital variant of folliculosebaceous cystic hamartoma, which has not been reported to date in Korea. We herein report a rare case of folliculosebaceous cystic hamartoma which occurred on the labia majora of a 28-year-old woman. Histopathologically, multiple, dilated, follicular, cystic structures were observed with numerous sebaceous lobules arising from its wall. There was an excess of fibrous components around these structures, which included small venules, adipocytes and neural tissue.
Adipocytes ; Adult ; Female ; Hamartoma* ; Humans ; Korea ; Nose ; Skin ; Venules

Fetal cystic hygromas are congenital malformations of the lymphatic system manifested as single or multiloculated fluid-filled cavities in the neck region. Cystic hygroma is characterized by cystic appearance of posterior or lateral portion of the neck. A case of cystic hygroma, diagnosed antenatally by ultrasound at the 11(+1)th week of pregnancy and confirmed by autopsy, is presented with a brief review of literatures.
Autopsy ; Gestational Age* ; Lymphangioma, Cystic* ; Lymphatic System ; Neck ; Pregnancy ; Ultrasonography

Campomelic syndrome is a very rare skeletal dysplasia with a characteristic pattern of deformity involving the proximal and distal extremities, pelvic and shoulder girdles, thoracic cage and palate. Respiratory compromise often leads to death in early infancy. Etiology has not been determined although evidence suggests genetic heterogeneity. Cytogenetic study revealed high incidence of a 46,XY karyotype in phenotypic females. Recently, we had experienced a case of campomelic dysplasia at amenorrhea 30weeks and termination was done, so we report with a brief review of literature.
Amenorrhea ; Campomelic Dysplasia* ; Congenital Abnormalities ; Cytogenetics ; Extremities ; Female ; Genetic Heterogeneity ; Humans ; Incidence ; Karyotype ; Palate ; Shoulder

If manometric profiles of sphincter of Oddi(SO) measured from the pancreatic duct and the bild duct are essentially equal, then measurement of manometric profiles from only one duct would be adequate in evaluating SO dysfunction. We report a series of 9 patients whom we evaluate with SO manometry. Cannulation of both the biliary sphincter segment and pancreatic sphincter segment was archived consecutively in one session and we compared the manometric parameters of choledochal sphincter from those of pancreatic sphincter. 1) In 7 out of 9 patients(78%), normal manometric finding of SO were seen in both choledochal and pancreatic sphincters. However, in 2 out of 9 cases(22%) abnormal manometric findings were noted in only one sphincter segment. Elevation of basal pressure(n = l) and increased retrograde propagation(n = 1) were found in the pancreatic sphincter segment alone. 2) Tbe mean intraductal pressure in the pancreatic duct was significantly greater(12.6+/- 5.8mmHg) than that of common bile duct(3.8+/- 3.3mmHg)(p<0.01). However, basal pressure, amplitude, frequency and propagation sequence in the phasic contraction of SO were not different significantly between choledochal and pancreatic sphincter segment. In conclusion, SO manometry of both the pancreatic and bile duct is needed if complete manometric information is desired. Selective cannulation of common bile duct and pancreatic duct during SO manometry is necessary in order to diagnose segmental 50 dysfunction.
Bile ; Bile Ducts ; Catheterization ; Common Bile Duct ; Humans ; Manometry ; Pancreatic Ducts ; Sphincter of Oddi

OBJECTIVE: To evaluate the availability and efficacy of the Lamellar body count as a predictor of fetal lung maturity METHODS: Amniocentesis was performed for evaluation of fetal lung maturity status within 72 hours of delivery in 32 patients. A Lamellar body count in clean amniotic fluid (AF) was analyzed right after amniocentesis. In case of contaminated AF with meconium or blood, samples was centrifuged for 3 minutes and divided into three. The average of three samples was analyzed successively from Coulter counter. RESULTS: The incidence of RDS showed significant relation with gestational age, 1-minute and 5-minute Apgar Score. Using a value greater than 30,000/ l to indicate pulmonary maturity, the Lamellar body count predicted all lung-maturated cases with no false-negative results (100% negative predictive value). All 4 cases of RDS demonstrated Lamellar body count less than 30,000/microl. By using a lower cutoff of 10,000/microl to predict pulmonary immaturity. Positive predictive value was 100% in RDS patients. CONCLUSION: In high risk pregnancy, fetal lung maturity test from amniotic fluid lamellar body count is a rapid, simple and reliable method in making a decision of delivery-time. And also it has universal availability with cost-effectiveness when we consider the reality of korean medical situation
Amniocentesis ; Amniotic Fluid ; Apgar Score ; Female ; Gestational Age ; Humans ; Incidence ; Lung* ; Meconium ; Pregnancy, High-Risk

We report a case of giant malignant gastrointestinal stromal tumor (GIST) accompanying an advanced gastric adenocarcinoma. A 73-year-old male patient was admitted to our hospital due to epigastric discomfort. In gastrofiberscopic examination, a localized Borrmann III gastric cancer at the lower body and antrum was noted. In endoscopic ultrasonographic examination, T3 hyperechoic advanced gastric cancer lesion and a relatively well-marginated heterogenous hypoechoic huge mass with a size of 10 cm were noted. In abdomen CT findings, localized wall thickening in the gastric antrum and the anterior wall, and a 11-cm-sized large heterogeneously enhancing mass in gastric body, posterior wall were noted. We did a radical subtotal gastrectomy, including a huge mass, with D2 lymph node dissection. Pathologic findings revealed double primary gastric neoplasms (synchronous occurrence of an adenocarcinoma and a huge GIST). Although closely juxtaposed, these two tumors had not merged and were separated by the thin rim of the muscularis propria.
Abdomen ; Adenocarcinoma ; Aged ; Gastrectomy ; Gastrointestinal Stromal Tumors* ; Humans ; Lymph Node Excision ; Male ; Pyloric Antrum ; Stomach Neoplasms* ; Stomach*

We aimed to setup an adaptive radiation therapy platform using cone-beam CT (CBCT) and multileaf collimator (MLC) log data and also intended to analyze a trend of dose calculation errors during the procedure based on a phantom study. We took CT and CBCT images of Catphan-600 (The Phantom Laboratory, USA) phantom, and made a simple step-and-shoot intensity-modulated radiation therapy (IMRT) plan based on the CT. Original plan doses were recalculated based on the CT (CTplan) and the CBCT (CBCTplan). Delivered monitor unit weights and leaves-positions during beam delivery for each MLC segment were extracted from the MLC log data then we reconstructed delivered doses based on the CT (CTrecon) and CBCT (CBCTrecon) respectively using the extracted information. Dose calculation errors were evaluated by two-dimensional dose discrepancies (CTplan was the benchmark), gamma index and dose-volume histograms (DVHs). From the dose differences and DVHs, it was estimated that the delivered dose was slightly greater than the planned dose; however, it was insignificant. Gamma index result showed that dose calculation error on CBCT using planned or reconstructed data were relatively greater than CT based calculation. In addition, there were significant discrepancies on the edge of each beam while those were less than errors due to inconsistency of CT and CBCT. CBCTrecon showed coupled effects of above two kinds of errors; however, total error was decreased even though overall uncertainty for the evaluation of delivered dose on the CBCT was increased. Therefore, it is necessary to evaluate dose calculation errors separately as a setup error, dose calculation error due to CBCT image quality and reconstructed dose error which is actually what we want to know.
Cone-Beam Computed Tomography ; Organothiophosphorus Compounds ; Uncertainty ; Weights and Measures

Most brachytherapy treatment planning systems employ a dosimetry formalism based on the AAPM TG-43 report which does not appropriately consider tissue heterogeneity. In this study we aimed to set up a simple Monte Carlo-based intracavitary high-dose-rate brachytherapy (IC-HDRB) plan verification platform, focusing particularly on the robustness of the direct Monte Carlo dose calculation using material and density information derived from CT images. CT images of slab phantoms and a uterine cervical cancer patient were used for brachytherapy plans based on the Plato (Nucletron, Netherlands) brachytherapy planning system. Monte Carlo simulations were implemented using the parameters from the Plato system and compared with the EBT film dosimetry and conventional dose computations. EGSnrc based DOSXYZnrc code was used for Monte Carlo simulations. Each (192)Ir source of the afterloader was approximately modeled as a parallel-piped shape inside the converted CT data set whose voxel size was 2x2x2 mm3. Bracytherapy dose calculations based on the TG-43 showed good agreement with the Monte Carlo results in a homogeneous media whose density was close to water, but there were significant errors in high-density materials. For a patient case, A and B point dose differences were less than 3%, while the mean dose discrepancy was as much as 5%. Conventional dose computation methods might underdose the targets by not accounting for the effects of high-density materials. The proposed platform was shown to be feasible and to have good dose calculation accuracy. One should be careful when confirming the plan using a conventional brachytherapy dose computation method, and moreover, an independent dose verification system as developed in this study might be helpful.
Accounting ; Brachytherapy ; Film Dosimetry ; Humans ; Monte Carlo Method ; Organoplatinum Compounds ; Population Characteristics ; Uterine Cervical Neoplasms ; Water