No abstract available.
Cervix Uteri* ; Conization* ; Female ; Pregnancy*

No abstract available.

BACKGROUND: Acute thoracic aortic dissections involving the aortic arch differ in diagnosis, surgical procedures, and operative results compared to those that do not involve the aortic arch. In general cerebral perfusion under deep hypothermic circulatory arrest (HCA) is performed during the repair of the aortic arch dissection. Here, we report our surgical results of the aortic arch dissection repair using retrograde cerebral perfusion (RCP) and its safety. MATERIAL AND METHOD: Between January 1996 and June 2002, 22 consecutive patients with aortic arch dissection underwent aortic arch repair. In 20 of them RCP was performed under HCA. RCP was done through superior vena cava in 19 patients and by systemic retrograde venous perfusion in 1, in whom it was difficult to reach the SVC. When the patient's rectal temperature reached 16 to 18oC, systemic circulation was arrested, and the amount of RCP amount was 481.1+/-292.9 ml/min with perfusion pressure of 20~30 mm Hg. RESULT: There were two in-hospital deaths (4.5%) and one late death (9.1%). Mean circulatory arrest time (RCP time) was 54.0+/-13.4 minutes (range, 7 to 145 minutes). RCP time has no correlation with the appearance of consciousness, recovery of orientation, or ventilator weaning time (p=0.35, 0.86, and 0.92, respectively). Ventilator weaning was faster in patients with earlier recovery of consciousness and orientation (r=0.850, r=926; p=0.000, respectively). RCP of more than 70 minutes did not affect the appearance of consciousness, recovery of orientation, ventilator weaning time, exercise time, or hospital stay (p= 0.42, 0.57, 0.60, 0.83, and 0.51, respectively). CONCLUSION: Retrograde cerebral perfusion time under hypothermic circulatory arrest during repair of aortic arch dissection may not affect recovery of orientation, ventilator weaning time, neurologic complications, and postoperative recovery.
Aorta, Thoracic* ; Circulatory Arrest, Deep Hypothermia Induced ; Consciousness ; Diagnosis ; Humans ; Length of Stay ; Perfusion* ; Vena Cava, Superior ; Ventilator Weaning

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.
Abscess ; Adult ; Aneurysm, False* ; Aneurysm, Infected ; Catheters ; Drainage ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Psoas Abscess* ; Psoas Muscles ; Spinal Fusion* ; Suppuration ; Transplants ; Vancomycin

No abstract available.
Ovarian Neoplasms*

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.
Adenomyosis ; Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Contraception ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Leiomyoma ; Mass Screening ; Menopause ; Mortality ; Obstetrics ; Pathology ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

Previous studies have shown that the cancer cell lines secrete multiple cytokines, such as macrophage colony-stimulating factor(M-CSF), granulocyte-macrophage colony stimulating factor(GM-CSF), interleukin-l(IL-1), interleukin-2(IL-2), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-alpha). We evaluated the levels of IL-2, IL-6, and TNF-alpha in the ascites of 23 patients with ovarian cancer. These levels were then compared with cytokine concentration found in 10 patients who had benign ascites and also studied the relation between levels of cytokines and clinical parameters. Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of cytokines in ascitic fluids. The median age of the group was 56, and the median follow-up time was 24 months. The levels of IL-2 was not elevated in ascites of ovarian cancer(30.5 vs 37.2 pg/ml, p=0.083), 1 he levels of TNF-alpha in the ascites with ovarian cancer were higher when compared with ascites of benign disease and was nearly approached statistically significant(91.0+/-20.7 vs 440.2+/-117.9pg/ml, p=0.058). Significantly higher IL-6 levels were detected in patients ascites compared with ascites with benign disease(354.3+/-42.9 vs 5,605+/-1,137pg/ml, p=0.006). IL-6 and TNF-a levels in ascites did not correlate statistically with tumor volume, histologic type or with survival time. IL-6 levels did not correlated statistically with volume of ascites. IL-6 and TNF-a levels did not correlated either. Circulating platelet counts in patients with ovarian cancer were significantly higher than in patients with benign conditions (282.6+/-5 vs 388.4+/-21.2x-10(9)/l, p=0.003). Thrombocytosis(platelet counts>400x10(9)/l) occured in 35%(8/23) of the cases with ovarian cancer. IL-6 levels in ascites correlated signi-ficantly with circulating platelet counts(R=0.427, p=0.042). This study showed that the patients with ovarian cancer have elevated levels of IL-6 in ascites. IL-6 levels were not correlate with disease status in patients with ovarian cancer. However, the correlation was found between IL-6 levels and thrombocytosis. This observation suggest a role for IL-6 in the development of tumor-associated thrombocytosis. A larger study would help in evaluating the potential biological roles and use of cytokines as tumor markers in ovarian cancer.
Ascites* ; Ascitic Fluid ; Blood Platelets ; Cell Line ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-2 ; Interleukin-6 ; Macrophages ; Necrosis* ; Ovarian Neoplasms* ; Platelet Count ; Thrombocytosis ; Tumor Burden ; Biomarkers, Tumor ; Tumor Necrosis Factor-alpha

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

Aortic and pulmonary valve endocarditis with patent ductus arteriosus (PDA) is uncommon in adult. A 60-year-old woman was diagnosed with aortic and pulmonary valve endocarditis and PDA. We describe our surgical experience for treating PDA with double valve endocarditis.
Adult ; Ductus Arteriosus, Patent ; Endocarditis ; Female ; Humans ; Middle Aged ; Pulmonary Valve

Incidence of valve leaflet escape after mechanical valve replacement is very low. We report a case of leaflet fracture and escape in an Edwards TEKNA bileaflet valve.
Heart Valve Prosthesis ; Incidence ; United Nations*