Traditionally, preeclamptic women who meet established criteria for severe disease aredelivered expeditiously. Although delivery is always appropriate thrapy for the mother, itmay not be for the fetus remote from term. The purpose of this investigation was to evaluatethe differences of pregnancy and neonatal outcome of severe preeclampsia and normalpregnancy, especially before 34 weeks gestational age, and to determine whether aggressiveor expectant management of severe preeclampsia before 34 weeks is more beneficial tomaternal and fetal outcome. A hundred and twenty consecutive pregnancies complicated bysevere preeclampsia and a hundred and twenty normal pregnancies were stuided.The results were as follows:1. The incidence of severe preeclampsia was 3.9%(130 of 3328). The 26~30 year oldage group was most common, 43%(52 patients).2. In case of study between severe preeclamptic patients and normal pregnant patient,there was no differences regarding gestational age at delivery, birth weight, cesarean sectionrate, incidence of RDS, perinatal death. The 1min/5 min Apgar scores of severe preeclampsiais significantly lower than control group(6/7 vs 7/8, p < 0.05). Neonates with SGA(small for gestational age) were found in 29% neonates of patients with severe preeclampsia,which is significantly higher than normal pregnancy group(6%, p < 0.05).3. There was no significant difference between expectant(n=10) and aggressive(n=21)management group less than 34 weeks gestation regarding the gestational age of admissionand delivery, blood pressure, proteinuria, serum creatinine, hemoglobin, hematocrit, pletelets,liver enzymes, and LDH. Only the prolongation of gestational age in the expectant managementgroup is significantly higher than in the aggressive management group(7 vs 2 days,p < 0.05).4. The neonatal and pregnancy outcome of expectant(n=10) and aggressive managementgroup(n=15) were as follow: The birth weight in the expectant management groupis lower than in the aggressive management group(1316.7+/-668.8g vs 1576.2+/-428.7 g, p < 0. 05). The incidence of SGA in the expectant management group is higher than in theaggressive management gorup(50% vs 27%, p=not significant). There was no significant differencebetween expectant and aggressive management group regarding the 1 min/ 5 minApgar score, the cesarean section rate, and the frequency of respiratory distress syndrome,cerebral hemorrhage, renal failure, sepsis, DIC of neonates.
Birth Weight ; Blood Pressure ; Cesarean Section ; Creatinine ; Dacarbazine ; Female ; Fetus ; Gestational Age ; Hematocrit ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn ; Mothers ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Proteinuria ; Renal Insufficiency ; Sepsis

BACKGROUND: A fibroadenoma is a common benign breast tumor with little potential for malignancy. There are, however, increasing numbers of reports that it is associated with a certain increase in breast cancer. METHODS: We reviewed the medical records of 4 patient's who were diagnosed as intraductal carcinoma within a fibroadenoma. RESULTS: The patient's age were relatively young (32, 36, 52, and 36 years), and the tumor presented as a lump of recent onset in 3 patients and as an abnormal mammography in one patient. None of the patients could be diagnosed as having malignancy by using mammography, ultrasonography, or cytologic examination. However, a radiologic study showed microcalcifications in the masses in two patients, and cytological examination demonstrated atypical cells in three patients. Breast-conservation surgery was performed in two patients; a wide excision was used in one and a localization & excision in the other. Pathologic features were ductal carcinomas in situ within fibroadenomas in all. Estrogen and progesteron receptors were all positive. CONCLUSION: Possibility of malignancy should be excluded in patients with a fibroadenoma, especially when microcalcifications are observed within the mass or atypical cells are suspected based on cytologic examination. Fine needle aspiration cytology, ultrasonography and even excisional biopsy should be performed to evaluate the possibility of malignancy in these patients.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Fibroadenoma* ; Humans ; Mammography ; Medical Records ; Ultrasonography

Small cell carcinoma of the cervix has been traditionally considered a rare subtype ofsquamous cell carcinoma characterized by a highly malignant behavior. However, it has becomeobvious that the majority of small cell carcinomas of the cervix expresses neuroendocrine,not squamous, differentiation. One case of intermediate cell neuroendocrine carinoma andthree cases of small cell undifferentiated carcinoma were reported. Patients ranged in age from37 to 50 (median, 44years) and presental as stages Ib(two patients), IIa(one patient), andIIb(one patient). One cases of intermediate cell neuroendocrine carinoma was combined with-endocervical adenocarcinoma and one case of small cell undifferentiated carcinoma was combinedwith adenocarcinoma in situ. All 4 tumors expressed one or more epithelial markers andneuroendocrine markers. Electron microscopically, neuroendocrine granules were observed inall 4 cases but large amount in intermediate cell neuroendocrine carinoma. A variety of treatmentregimens was employed. One patient with intermediate cell neuroendocrine carinoma isalive now for 60 months after starting of treatment. But two of three patients with small cellundifferentiated carcinoma died of disease (34, 45 months) and one of them is alive now for20 months. One patient had spinal metastasis and paraplegia which were treated twice withsurgery and irradiation on tumor bed and the other patient was comatose with multiple livermetastasis. Small cell undifferentiated carcinoma of the cervix was more aggressive thanintermediate cell neuroendocrine carcinoma of the cervix. We can differentiate small cellundifferentiated carcinoma of the cervix from intermediate cell neuroendocrine carcinoma of thecervix, pathologically, ultrastructurally and immunocytochemically.
Adenocarcinoma ; Carcinoma ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell* ; Cervix Uteri* ; Coma ; Female ; Humans ; Neoplasm Metastasis ; Paraplegia

BACKGROUND: Fibroadenoma is a common benign breast tumor that has a rare malignancy rate. However, various studies reported that it is associated with a certain increase in breast cancers. CASES: We report three cases of malignancy arising from a breast fibroadenoma. They were 32, 36 and 52 years old and presented with a lump of recent onset. Any one of mammography, ultrasonography and cytologic examination could diagnose malignancy exactly. But cytological examination demonstrated atypical cells with fibroadenoma in two cases. Wide excision was performed in two cases and localization & excisional biopsy was performed in an occult case. Pathologic report of the cases revealed them as DCIS in a fibroadenoma. CONCLUSION: Possibility of malignancy cannot be excluded in fibroadenomas especially in case with calcifications within the mass in the radiological study or with atypical cells presented in the cytology. Cytology and ultrasonogram should be used to evaluate fibroadenomas. If there are any suspicion of malignancy, excisional biopsy should be performed to confirm the benign state.
Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Fibroadenoma* ; Humans ; Mammography ; Middle Aged ; Ultrasonography

The objective of this study was conducted to investigate growth and development status of infants fed soy-based formulas over 3 months. The height and weight were measured and Z-scores were calculated by using standard of the same age groups. Their mothers were interviewed using questionnaires including general and environmental characteristics, total food intakes, soy based formula intakes and Ewha infant development screening test. Main results were as follows: 1) Nutrient intake levels of subjects were similar to or more than the level of Korean Recommended Dietary Allowances except for intakes of vitamin E (79.89% RDA), and the average status of nutrient intakes of infants were fairly good. 2) Z-scores of height for age (HAZ) and Z-scores of weight for age (WAZ), Kaup index, WLI and Ewha Infant Developmental Screening Test score of subjects were in the normal growth range. 3) There were no significant differences among soy based formula intake percentile groups in HAZ, WAZ, Kaup index, WLI and Ewha Infant Developmental Screening Test score. 4) Total energy intake was positively correlated with HAZ (p < 0.01), WAZ (p < 0.01), and WLI (p < 0.05) in infants less than 12 month. Also, soy based formula energy intake was positively correlated with HAZ (p < 0.05) in infants less than 12 month. However, energy and soy based formula intake levels of infants over 12 month were not significant among variables. Considering results of this study, infants fed soy-based formulas over 3 months showed normal growth and development status. Further studies are needed to evaluate long-term growth and development in infants fed soy based formulas.
Child ; Child Development ; Energy Intake ; Growth and Development* ; Humans ; Infant* ; Mass Screening ; Mothers ; Recommended Dietary Allowances ; Vitamin E ; Vitamins

BACKGROUND: Current evidence implicates specific types of the human papillomavirus (HPV) are involved in the development of cervical cancer. In HPV-negative cervical carcinomas, p53 mutation is thought to be a mechanism of oncogenesis. The purpose of this study was to evaluate the prevalence of p53 mutations in cervical adenocarcinomas and to investigate their correlation with HPV status and clinicopathologic parameters. METHODS: A series of 38 primary cervical adenocarcinomas was analyzed for both HPV infection and p53 mutations. The HPV 16, 18, and 33 status was investigated by PCR amplification. The point mutations of the p53 gene were detected by the PCR-SSCP technique. RESULTS: The prevalence of HPV 16, 18, or 33 infection was 73.7% (28/38). HPV 16 was present in 12 cases, HPV 18 was present in 15 cases, and HPV 33 was positive in one case. There was only one case that was positive for 18 as well as a p53 mutation in exon 6. CONCLUSIONS: Our results indicate that HPV 18 infection was more common in cervical adenocarcinomas than HPV 16 infection. Mutant p53 was rarely found in cervical adenocarcinomas regardless of the type of HPV infection. There was no correlation between HPV infection and clinical stage or pathologic type of tumor.
Adenocarcinoma* ; Carcinogenesis ; Cervix Uteri* ; Exons ; Female ; Genes, p53* ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans* ; Point Mutation ; Polymerase Chain Reaction ; Prevalence ; Uterine Cervical Neoplasms

A case of huge cystosarcoma phyllodes is presented. A 45-year-old female visited our clinic because she had had a mass in the right breast for two and a half years. She had performed breast mass excisions at the same site on 2 different occasions, 5 and 3 years ago. The tumors consisted of benign phyllodes, and there had been necrosis with a foul odor in half of the mass surface. A total mastectomy was performed due to the large size (30x22 cm), the recurrent nature and a fear of malignancy. The tumor was somewhat incompletely well-encapsulated and was adherent to the pectoralis major. Pathologic findings revealed that the tumor was made up of malignant cystosarcoma phyllodes.
Breast ; Female ; Humans ; Mastectomy, Simple ; Middle Aged ; Necrosis ; Odors ; Phyllodes Tumor*

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which is first described by Carcangiu in 1984. It is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and the prognosis of the insular thyroid carcinoma. MATERIALS AND METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and mean age was 44 years. Three of four patients complained anterior neck mass and one patient complained low back pain and paresthesia of right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology could diagnose follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extra- thyroidal invasion, vascular invasion and multicentricity was noted in two cases. All four patients showed recurrence or distant metastasis in follow up period of 10~31 months and 2 of them died of distant metastasis. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinoma.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Low Back Pain ; Neck ; Neoplasm Metastasis ; Paresthesia ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Thigh ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

OBJECTIVES: To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.
Eating ; Education ; Female ; Health Behavior* ; Health Promotion ; Humans ; Incidence ; Korea* ; Male ; Marital Status ; Meals ; Smoke ; Snacks ; Social Security

OBJECTIVE: To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities. METHODS: Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. RESULTS: Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. CONCLUSION: For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.
Activities of Daily Living ; Botulinum Toxins ; Botulinum Toxins, Type A ; Cerebral Palsy ; Child ; Follow-Up Studies ; Humans ; Learning ; Muscle Spasticity ; Prospective Studies ; Upper Extremity