PURPOSE: To evaluate the usefulness of Gd-DTPA enhanced MR imaging in determining the metastatic lymph nodes in uterine cervical carcinoma. MATERIALS AND METHODS: Sixty nine patients with histologically proven cervical carcinoma underwent Gd-DTPA enhanced MR imaging. One hundred and thirty-eight pelvic regions(69 right,69 left) in 69 patients were analyzed for lymph node metastases. Pelvic lymph nodes were considered to be abnormal if they were greater than lcm in diameter and were enhanced on postcontrast T1 weighted images. RESULTS: Metastatic lymph nodes were found in 22 pelvic regions by surgicopathologic examinations. On MR imaging there were 14 true positives, 106 true negatives, 10 false positives and 8 false negatives. Gd-DTPA enhanced MR image had an accuracy of 86.9%, a sensitivity of 58.3%, a specificity of 91.4%, a positive predictive value of 58.3% and negative predictive value of 92.9% in evaluation of pelvic lymph node metastases. CONCLUSION: MR imaging with contrast enhancement may be useful in the evaluation of pelvic lymph node metastases in patients with uterine cervical carcinoma.
Gadolinium DTPA ; Humans ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Pelvis ; Sensitivity and Specificity

Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd's procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.
Adult ; Humans ; Infant, Newborn ; Infarction ; Intestinal Obstruction ; Intestinal Volvulus ; Mesenteric Artery, Superior ; Mesenteric Veins ; Portal Vein ; Sepsis ; Thrombosis ; Vomiting

During the microsurgery or during the postoperative period, the occurrence of the vascular spasm increases the failure rate of microvascular anastomosis,and in cases of trauma, the thrombogenic possibility is increased by the endothelial damage. The author thought that the vascular freezing of crushed vessels could improve the patency rate of microvascular anastomosis. Vascular freezing destroys most of the cells in the intima and media. There by causing degeneration of adrenergic fibers. Even though regeneration occurs after 2-3 weeks, regeneration in the smooth muscle layer is still incomplete. So vascular freezing has beneficial effects on relief of vasospasm. Fifteen Sprague-Dawley rats weighing approximately 300 g each were inflicted with crushing injury on the femoral arteries of the right side and the crushing injury with vascular freezing on the femoral arteries of the left side. The gross and histologic findings, as well as the patency rates, were observed at the postoperative 2nd, 10th, and 30th day,and the results were compared between the crushed and crush-freezing groups. The left side (crush-freezing group) showed less vasospasm and less thrombogenesis than the right side (crushed group). There were no significant differences in the patency rate between the crushed group and crush-freezing group. Vascular freezing is suggested to be effective on a potentially thrombogenic, endothelial damaged vessel as a prophylactic treatment method against vasospasm. Clinical application of vascular freezing awaits further experimentation.
Adrenergic Fibers ; Endothelium* ; Femoral Artery ; Freezing* ; Microsurgery ; Muscle, Smooth ; Postoperative Period ; Rats, Sprague-Dawley ; Regeneration ; Spasm

No abstract available.
Breast Neoplasms* ; Breast*

No abstract available.
Female ; Ovary*

BACKGROUND: Endocrine pancreas tumor is a rare disease which incidence is less than 2% of all pancreatic tumors. But it comprises various types of tumor and usually secretes several hormones from one type of tumor although the patient with this tumor complains of sole symptom associated with only one hormone. The mechanism and clinical significance of multiple hormone secretion in the endocrine pancreas tumom are not yet clearly defined. METHODS: We analyzed retrospectively the clinicopathologic features of 20 cases which were operated at Seoul National University Hospital during the period between February 1989 and May 1998. RESULTS: The most common tumor was insulinoma (13 cases) and the second most common tumor was nonfunctioning tumor (6 cases). There was one case of somatostatinoma. Most of the patients with insulinoma complained of neuroglycopenic symptoms. There were 9 cases (45.0%) in which the tumors secreted more than two kinds of hormones, 7 cases in insulinoma, 2 cases in nonfunctioning tumors. Whether the tumor secreted multiple hormones was detected by the method of immunohistochemical staining. Though the tumors secreted more than two kinds of hormones, the patients with the tumors complained of symptoms which were associated with the cell type most strongly stained by immunohistochemical method. Whether or not the tumors secreted multiple hormones was not associated with the pathologic features such as tumor size, histologic patterns of the tumor, status of tumor cell differentiation and malignancy. CONCLUSION: From this results, we suggest that endocrine tumors of the pancreas secreted multiple hormones not by the mechanism of dedifferentiation from already differentiated endocrine cells but by the mechanism of neogenesis of multipotent islet stem cells. Since the relationship between the function of multiple hormone secretion in the endocrine pancreas tumors and islet stem cell would be significant, further study should be needed to find out the function of stem cells and application of stem cells to clinical use.
Cell Differentiation ; Endocrine Cells ; Humans ; Incidence ; Insulinoma ; Islets of Langerhans ; Pancreas* ; Rare Diseases ; Retrospective Studies ; Seoul ; Somatostatinoma ; Stem Cells

BACKGROUNDS: Reflux esophagitis has been known to be a frequent complication after a total gastrectomy. Reflux esophagitis is very annoying to the patients, so various types of reconstructions has been introduced to eliminate this complication. METHODS: This study is a retrospective clinical analysis of 34 patients with gastric cancer who were treated with a total gastrectomy from January 1989 to December 1997 at the Department of Surgery, Seoul Adventist Hospital. RESULTS: During 9 years, the operation was performed on 194 patients with gastric cancer, amomg which 34 (17.3%) were total gastrectomies. The peak age was in the 5th and the 6th decades (58.8%), and the sex ratio of males to females was 1.6:1. The sites of the stomach cancer were the cardia (C) in 10 cases (29.4%), the body (M) in 19 cases (55.9%), and the cardia and body in 5 cases (14.7%). The TNM classification was stage I in 15.6% of the cases, stage II in 15.6% of the cases, stage III in 62.5% of the cases, and stage IV in 6.3% of the cases. Three methods of alimentary tract reconstruction were used:a loop esophagojejunostomy with a Braun anastomosis (27), a Roux-en-Y esophagojejunostomy (6), and an uncut Roux procedure (1). The reflux esophagitis rates for patients treated with a loop esophagojejunostomy with a Braun anastomosis and for patients treated with a Roux-en-Y esophagojejunostomy were 25.9% and 16.7%, respectively. The perioperative mortality was 5.8%, and the causes of death were pneumonia and anastomotic leakage. The most common recurrent site was the anastomotic site. CONCLUSIONS: Reflux esophagitis developed more often after a loop esophagojejunostomy with a Braun anastomosis than after a Roux-en-Y anastomosis. This finding was not significant statistically. Thus, further study of more cases is needed.
Anastomosis, Roux-en-Y ; Anastomotic Leak ; Cardia ; Cause of Death ; Classification ; Esophagitis, Peptic* ; Female ; Gastrectomy* ; Humans ; Male ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sex Ratio ; Stomach Neoplasms*

This is an analysis of 174 patients classified as generalized vitiligo by Ortonnes' classification during the period from May till December in 1985. The retults are summarized as follows. There were 89 females(51.l%) and 85 males(48, 9%). 2. The mean age of onset was 24.2 years(male: 23.4, female: 24. 8). 3. The mean age at the first visit was 33 years(male: 32. 2, female: 34, 8) 4. The mean duration of t.he disease was 10. 8 years (male: 10. 3, female: 11. 3). 5. The mean interval between onset and visiting was 9 years(male: 8. 8, female: 10). 6. Mode of onset was unicentric in 90, 2% and multicentric in 9. 8% 7.The most common site of initial involvement was abdomen(15. 0%). 8. The most common precipitating factor was trauma(11%). 9.The most common previous treatment was sunlight irradiation after application of topical oxoralene(33.3%). 10. The most common degree of depigmented lesion was 5~10%.(39.7%). 1l. Family history was present in 12% and thyroid disease was associated in only one case.
Age of Onset ; Classification ; Female ; Humans ; Precipitating Factors ; Sunlight ; Thyroid Diseases ; Vitiligo*

Endometriosis in the episiotomy scar following vaginal delivery is one of the very rare condition among the extrapelvic endometriosis. We have experienced two cases of endometriosis in the episiotomy scar following vaginal delivery. We report two cases with a brief review of the concerned literatures.
Cicatrix* ; Endometriosis* ; Episiotomy* ; Female

We report a case of epidermal nevus syndrome showing various skin manifestations improved with CO₂ laser and chemical peeling in a 11-year-old girl. Skin lesions were composed of linear verrucous plaques and numerous papillomatous papules on the face, neck, scalp and trunk, multiple congenital nevocellular nevi on the face, and extensive cafe au lait spots on the trunk. The associated findings of skeletal involvement were gingival hemihypertrophy and benign bone lesion of the 7th rib. CO₂ laser and chemical peeling MCA, 50% TCA) were applied to remove these skin lesions which improved considerably.
Cafe-au-Lait Spots ; Child ; Female ; Humans ; Neck ; Nevus* ; Ribs ; Scalp ; Skin Manifestations* ; Skin*