OBJECTIVES: To evaluate the relation between diagnostic clinical parameters and the depth of trophoblastic invasion in tubal pregnancy and decide the most predictable parameter. Methods: Total 50 patients who were confirmed as tubal pregnancy pathologically, from Jan. to Dec. 1997, were included in this study. Menstrual missed periods was calculated by clinical history, volume of gestational mass was calculated as sphere, beta-hCG was titered with preoperative blood sample. All surgical specimens were examined pathologically and divided into two groups such as intraluminal and extraluminal, defined as intact tubal musculature and trophoblastic invasion beyond musculature, n=22 and n=28, respectively. Statistical analysis was performed among three parameters and between each parameter and the depth of trophoblastic invasion. Statistical analysis included were Student's t-test, Chi square, linear regression, and linear correlation analysis using SPSS statistical package and statistical significance was determined as p<0.05. RESULTS: There was a correlation between volume of gestational mass and beta-hCG(p<0.05), but not between beta-hCG and missed period or volume of gestational mass and missed period. beta-hCG level was 1843.7+/-1524.7 mIU/ml(Mean+/-SD) in intraluminal and 12144.3+/-10561.6 mIU/ml(Mean+/-SD) in extraluminal. There was a predictive correlation between beta-hCG and the depth of trophoblastic invasion(p<0.05), and cut off level 3,500 mIU/ml showed the highest sensitivity, specificity, positive predictive value, negative predictive value, 0.79, 0.86, 0.88, 0.76, respectively. Two parameters(volume of gestational mass and missed period) had no ability to predict whether intraluminal or extraluminal. CONCLUSION: We suggest that successful medical treatment of tubal pregnancy depend on lesional intactness of vasculature for drug delivery. In patient selection for medical treatment, it should be important to predict intraluminal type because of intact vasculature. Of clinical parameters, beta-hCG is single most predictive parameter, cut off level of 3,500 mIU/ml was the most reasonable level in this study.
Female ; Humans ; Linear Models ; Patient Selection ; Pregnancy ; Pregnancy, Tubal* ; Sensitivity and Specificity ; Trophoblasts*

46, XX male is a rare sex cluomasomal constitution characterized by the development of bilateral testis in persons who lack a Y chomosome. The majority of affected persons have normal external genitalia and usually seek medical advice due to infertility, hypogonadism and/or gynecomastia in adulthood. Although Y chromosomsl sequences can be detected in the majority of male subjects with 46, XX karyotype, several studies have shown thst approximately 10 % of patients lack Y chromosomal material including the SRY ( sex-determining region of Y-chromosome) gene. Several hypothesis have been proposed to explain the etiology of this constitution. 1. Translocation of the testis-determining factor (TDF) fiom the Y to the X chromosome or autosome. 2. Acquisition of Y chromosome function by a mutant autosomal or X-linked gene. 3. Undetected mosaicism with Y-bearing cell line 4. Loss of Y chmmosome hom the XXY Klinefelter zygote. We experienced a case of 46, XX male who was 30 years old. We report a case with review of the literature.
Adult ; Cell Line ; Constitution and Bylaws ; Genes, X-Linked ; Genitalia ; Gynecomastia ; Humans ; Hypogonadism ; Infertility ; Karyotype ; Male* ; Mosaicism ; Sex-Determining Region Y Protein ; Testis ; X Chromosome ; Y Chromosome ; Zygote

Arteriovenous malformation of the uterus is rarely encountered. It is potentially lethal because of profuse, uncontrollable bleeding at the time of diagnostic dilatation and curettage. To our knowledge, only 38 cases of localized uterine arteriovenous malformation have been reported in English and Korean literature. Recently we experienced a case of uterine arteriovenous malformation in a 28-year-old multiparous woman. Under the clinical impression of uterine tumors or arteriovenous malformation, a total hysterectomy was done. Gross examination demonstrated a vascular nature of the mass in the posterior wall of the fundus. Microscopically, there was an ill-defined mass composed of numerous irregular, anastomosing large vessels with various diameters.
Female ; Humans

From December 1986 to August 1988, three patients with early prostatic cancer diagnosed primarily by fine needle aspriation cytology and/or Tru-cut needle biopsy underwent potency preserving radical retropubic prostatectomy. Herin we report the results and associated problems. Most difficulty was the diagnosis of the early prostatic cancer. We used fine needle aspiration cytology to diagnose the prostatic cancer primarily. One case of class V on the preoperative cytologic examination has proved to be BPH with chronic prostatitis postoperatively. Another problem was possibility of major bleeding intraoperatively, and complications were uncommon and not serious.
Biopsy, Fine-Needle ; Biopsy, Needle ; Diagnosis ; Hemorrhage ; Humans ; Needles ; Prostatectomy* ; Prostatic Neoplasms ; Prostatitis

From December 1986 to August 1988, three patients with early prostatic cancer diagnosed primarily by fine needle aspriation cytology and/or Tru-cut needle biopsy underwent potency preserving radical retropubic prostatectomy. Herin we report the results and associated problems. Most difficulty was the diagnosis of the early prostatic cancer. We used fine needle aspiration cytology to diagnose the prostatic cancer primarily. One case of class V on the preoperative cytologic examination has proved to be BPH with chronic prostatitis postoperatively. Another problem was possibility of major bleeding intraoperatively, and complications were uncommon and not serious.
Biopsy, Fine-Needle ; Biopsy, Needle ; Diagnosis ; Hemorrhage ; Humans ; Needles ; Prostatectomy* ; Prostatic Neoplasms ; Prostatitis

On a standpoint of commonly available ESWL for the treatment of urinary stone, percutaneous stone extraction had the role of cooperation to it, and sometimes it could be the first procedure of choice. We have performed percutaneous extraction of the renal and upper ureteral stones in 35 renal unite. The overall success rate was 78.4%, average operation time was 81 minutes, mean fluoroscopic exposure time was 11 minutes, average postoperative hospital stay was 7 days. Causes of failure were as followings ; five inadequate calyceal puncture, one ureteral perforation, one impacted stone, and one downward stone migration. The complications were inappropriate position of the nephrostomy tube, prolonged hematuria through nephrostomy tube, and partial ureteral avulsion. They were not serious but resolved by conservative management.
Hematuria ; Length of Stay ; Punctures ; Ureter ; Urinary Calculi

Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.
Adult ; Amniotic Fluid* ; Anoxia ; Embolism ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Pregnancy ; Respiratory Distress Syndrome, Adult

Sarcomatoid carcinomas are malignant epithelial neoplasms in which the tumor cells assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. These spindle cells are malignant and manifest various amount of both vimentin and cytokeratin. Positive reaction of some of the spindle cells for cytokeratin antibodies is confirmatory. Clinical features do not differ significantly from those of patients with high-grade transitional cell carcinoma. So far, 13 cases of sarcomatoid transitional cell carcinoma of the renal pelvis have been reported in English and Korean literature. In this report, we describe clinicopathologic features of recently observed two cases of sarcomatoid transitional cell carcinoma of the renal pelvis and summarize the pathologic findings of previously reported cases with review of the literature.
Antibodies ; Carcinoma ; Carcinoma, Transitional Cell* ; Carcinosarcoma ; Classification ; Humans ; Keratins ; Kidney Pelvis* ; Sarcoma ; Vimentin

Proliferative fasciitis is a rare reactive condition that presents with pseudosarcomatous lesions in subcutaneous tissues. Clinically, most patients present with firm, rapidly growing subcutaneous nodule and two thirds of patients complained of pain and tenderness. Most of lesions occur in the extremities, with the upper extremity (especially the forearm) affected more commonly than the lower extremity. Microscopically, proliferative fasciitis is composed of spindle cells that are deposited in a variably myxoid and collagenous stroma. It is characterized by the presence of large basophilic cells with one or two vesicular nuclei. Proliferative fasciitis could be confused with sarcomas because of intense cellularity, high mitotic index, and rapid growth. A 26-year-old woman complained of a painful nodule on her right second finger. Its size was gradually increased and pain was worsened. Histopathological examination revealed that the lesion consisted predominantly of spindle-shaped cells intermingled with a few gangliocyte-like giant cells. We herein report a rare case of proliferative fasciitis in the finger in a 26-year-old woman.
Adult ; Basophils ; Collagen ; Extremities ; Fasciitis* ; Female ; Fingers* ; Giant Cells ; Humans ; Lower Extremity ; Mitotic Index ; Sarcoma ; Subcutaneous Tissue ; Upper Extremity

No abstract available.
Dyspnea* ; Humans