In 1988, the International Federatioa of Gynecology and Obstetrics(FIGO) Cancer Committee changed the staging of endometrial carcinoma from a clinical one to a surgicopathologic one. The emphasis in the new FIGO system was changed to the pathologic findings in the uterus, cervix, adnexae, and pelvic and/or periaortic nodes, and peritoneal cytologic findings. The major changes in this staging system were the use of the depth of myometrial invasion and the identification of tumor cells in peritoneal cytologic examination and of invasion in the retroperitoneal lymph nodes, Preoperative endocervical curettage was no longer necessary. This is a reflection of the increase in the primary surgical approach to the treatment of this disease and has allowed the identification of a number of prognostic factors on which postoperative therapy can be based. This retrospective study was based on a clinical review of 45 patients with endometrial carcinoma from Jan, 1985 through Jan, 1996 who underwent primary surgical evaluation at the Department of Obstetrics and Gynecology, Kyungpook National University Medical College. The results obtained are as follows; l. Age distribution of endometrial cancer was concentrated on the age group of 50-59(55.6%) and mean age was 53.9 years. 2. The mean parity and mean BMI(Body Mass Index) of endometrial cancer were 3.8 and 25.0(cm/kg2). 3. The Menstrual status at the time of development of endometrial cancer showed that 24 cases (53.3%) were postmenopausal, 11 cases (24.4%) were premenopausal and 10 cases(22.2%) were menstruating. 4. According to the clinical stage adopted by FIGO classification, stage I was found in 71.1%, stage II in 17.8%, stage III in 2,2%, stage IV in 0.0%. 5. Surgical restaging according to new FIGO classification(1988), stage IA was found in 4.4%, stage IB in 37.8%, stage IC in 28.9%, stage IIA in 0.0%, stage IIB in 0.0%, stage IIIA in 6.7%, stage IIIB in 4.4%, stage IIIC in 8.9%, stage IVA in 2.2% and IVB in 6.7%. 6. According to WHO histopathological classification, the percentage of the adenocarcinoma was 86.7%, adenoacanthoma 4.4%, papillary serous adenocarcinoma 2.2%, and adenosquamous cell carcinoma 6.7%. 7, The relationship between histologic grade and depth of invasion was somewhat correlated but no staistical significance. 8. There was no correlation between BMI(Body Mass Index) and histologic grade, depth of invasion. 9. Surgery upstaged 15.6% of clinical stage I patients and 62,5% of clinical stage II, but 37.5% of clinical stage II patients was downstaged. 10. All cases were primarily treated by surgery. Regarding the types of operation, total abdominal hysterectomy with bilateral salpingoophorectomy was performed in 44.4%, radical hysterectomy with both pelvic lymphadnectomy in 42.2%, total abdominal hysterectomy with bilateral salpingoophorectomy with selective pelvic lymph node dissection in 8.9%, and laparoscopic assisted vaginal hysterectomy in 2.2%. 11. The mean follow up interval was 38.6 months. 28 cases were followed up and 10 cases of surgical stage I revealed over 5 year salvage. 5-year survivals for surgical stage IA, IB, IC, III, and IV were 100, 100, 92.3, 88.9, and 100%, respectively.
Adenocarcinoma ; Age Distribution ; Cervix Uteri ; Classification ; Curettage ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Gynecology ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Staging ; Obstetrics ; Parity ; Retrospective Studies ; Uterus

Since succinyl choline was introduced, into clinical anesthesia, it has been used as main muscle relaxant because of its rare side effects and short duration of action. Our interest in the effects of this drug on extraocular muscles and intraocular pressure began in 1957 following reports of vitreous expulsion in patients who received succinylcholine during ocular surgery. The effects of muscle relaxants on the intraocular pressure were studied in 60 healthy human subjects. When succinylcholine was given alone, 20 human subjects had a mean increase in intraocular pressure of 10. 5 mmHg. When gallamine 2. 5 mg/kg or pancuronium 80 ug/kg was used, 20 subjects showed a mean decrease of 3. 1 mm Hg from control. Giving gallamine (20 mg) or dtubo curarine(3 mg) 2-3 minutes prior to the administration of succinylcholine, 20 human subjects had no significant change in intraocular pressure. This simple method prevents the increase in intraocular pressure associated with the use of succinylcholine.
Anesthesia ; Choline ; Gallamine Triethiodide ; Humans ; Intraocular Pressure* ; Methods ; Muscles ; Pancuronium ; Succinylcholine

We report computed tomography (CT) and magnetic resonance (MR) findings of a patient with polyostotic Paget disease and multicentric giant cell tumor (GCT). Brain CT scan showed widening of diploic space, cortical thickening and enhancing soft tissue mass in occiput with underlying calvarial destruction. Ill-defined soft tissue masses were also detected in maxillary sinus and buttock with underlying bony destruction on CT. MR image showed multifocal nodules in wide diploic space with low signal intensity on T1 -weighted image and bright signal intensity on T2-weighted image. Mass in occiput showed homogeneous hypointensity to bone marrow on T1-weighted image and homogeneous iso- intensity on T2-weighted image. Multiple nodules in diploic space and occipital mass showed contrast enhancement following administration of Gd-DTPA. Biopsy was performed at scal p, maxillary sinus and buttock, and histologic analysis revealed GCT.
Biopsy ; Bone Marrow ; Brain ; Buttocks ; Gadolinium DTPA ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Maxillary Sinus ; Tomography, X-Ray Computed

The dislocation of metacarpophalangeal joint of the index is apparently rare injury and produeed by striking of the volar surface of the outstretched index against a resistent object. This injury presents certain characteristics which make it distinctly different from dislocation of the thumb or little finger. The proximal phalanx is displaced over the dorsum of the corresponding metacarpal, the hand is deformed, and the index is inclined toward the middle finger. In 1957 Kaplan reported his study about the pathological anatomy and proper treatment technique in the dislocation of the metacarpophalangeal joint of the index finger. In this type of dislocation, closed reduction, even if performed immediately after the injury, is unsuccessful, and open reduction is mandatory. The authors have experienced a case of dorsal dislocation of the metacarpophalangeal joint of the index finger developed 3 weeks prior to admission on 20 th, May, 1985.
Dislocations ; Fingers ; Hand ; Metacarpophalangeal Joint ; Strikes, Employee ; Thumb

This rare tumor has been diagnosed postoperatively in a 64-years-old male patient. Herein a case of extra-adrenal paraganglioma of the retroperitoneum is presented with brief review of literatures.
Humans ; Male ; Paraganglioma, Extra-Adrenal*

Microinvasive carcinoma of the uterine cervix(Stage Ia) is the earliest stage of squamous carcinoma. The transition from preinvasive to invasive disease is a crucial juncture in the development of cervical cancer. The clinical experience that microinvasive lesions carry a better prognosis justifies a separate diagnostic category. To investigate the clinical and pathological aspects of microinvasive cervical carcinoma, a retrospective study was made on 84 cases, histologically reconfirmed surgical specimens, which had been treated during the period from January, 1985 to December, 1996 at Department of Obstetrics and Gynecology, Kyung-pook National University Hospital. We defined microinvasive carcinoma as stromal invasion not exceeding a depth of Smm from the base of the epithelium presented by FIGO in 1985. The results obtained were as follows; 1. Mean age of 84 patients was 46.9 year old, all were parous women but not 1 patients. 60 cases(71.4%) belonged to stage Ial and 24 cases(28,6%) to stage Ia2. 2. Chief complaints were postcoital spotting and leukorrhea. 3, The corresponding rate of Pap. smear to histologic diagnosis was approximately 29.8%. However correponding rate within one histologic grade was about 33,3%. 4. According to the colposcopic examination, 26.4% of cases revealed suspected abnormal findings suggesting invasive lesion. 5. As to the reports of punch biopsy, 55.1% of cases showed microinvasive and/or invasive lesion. With additional diagnostic conization of cervix, the preoperative diagnosis were correct in 72%. 6. Operation performed were simple hysterectomy, extrafascial hysterectomy or modified radical hysterectomy with both pelvic LN dissection, Simple hysterectomy was most commonly performed. 7. Post-treatment complications were developed in 73.9% of patients who were done with modified radical hysterectomy with both pelvic LN dissection and bladder dysfunction was developed in 50% of the patients.
Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Conization ; Diagnosis ; Epithelium ; Female ; Gynecology ; Humans ; Hysterectomy ; Leukorrhea ; Metrorrhagia ; Obstetrics ; Prognosis ; Retrospective Studies ; Urinary Bladder ; Uterine Cervical Neoplasms

Changes of alveolar-arterial oxygen tension differences (AaDO2) after 35 cases of open heart surgery were evaluated with durations of extracorporeal circulation and prognosis. Following results were obtained. 1) AaDO2 values of pre-bypass in fatal open great cases were higher than in survival cases. 2) AaDO2 values of post-bypass were similar and noted no correlation to progonsis. 3) Luration of extracorporeal bypass time in fatal cases were longer than in survival cases. 4) Changes of AaDO2 values after extracorporeal circulation were much correlated to AaDO2 of pre-bypass than those of post-bypass.
Extracorporeal Circulation ; Oxygen ; Prognosis ; Thoracic Surgery

Hepatocellular carcinoma(HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration(FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesion-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block material, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level(over 400 I. U.). All aspiration smears were stained by the Papainicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endothelial lining, multinucleated giant cells, eosinophilc, globules bile and Mallory body. Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern(80.3%). The irregular(12.6%), the acinar(5.5%), and the dispersed patterns(1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells : the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows : intranuclear cytoplasmic inclusion in 86.8% ; endothelial lining in 56.1% ; bile in 19.8% ; and giant cells in 60.1%. Clear cells were often present in 11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern. hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.
Adenoma, Liver Cell ; alpha-Fetoproteins ; Anaplasia ; Bile ; Biopsy ; Biopsy, Fine-Needle* ; Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Endothelial Cells ; Eosinophils ; Fibrosis ; Giant Cells ; Hepatocytes ; Inclusion Bodies ; Korea ; Liver ; Mitosis ; Necrosis ; Needles ; Regeneration ; Retrospective Studies

The authors have experienced two cases of general anesthesia for repair of congenital diaphragmatic hernia. Both patients were female (1 year 5 months and 8 months of age) and had left sided Bochdalek hernia. Anesthesia was maintained with halothane-oxygen using nonrebreathing system with Ruben valve, and the patients tolerated the whole procedure very well. The importance of maintaining adequate ventilation with high concentrations of oxygen and avoiding abdominal distension has been stressed.
Anesthesia ; Anesthesia, General ; Female ; Hernia ; Hernias, Diaphragmatic, Congenital* ; Humans ; Oxygen ; Ventilation

Sudden operative death due to massive tumor embolism occurred during operation. During the course of anesthesia for pneumonectomy, this 54-year-old male patients showed continuous hypotension, weak or absent pulse of radial, external carotid, femoral and doralis pedis artery of the right side. But those of the other side were within normal range and anesthesia went on uneventfully. As the patient failed to gain consciousness postoperatively, immediate emboleetomy under general anesthesia was performed under the impression of massive tumor embolism. Multiple tumor emboli were removed from the innominate arteries, right common carotid and right brachial artery. After operation of embolectomy, arterial blood pressure and pulse measured on the right side were regained. However, the patient failed to return to his consciousness and died due to unexpected cardiac arrest, 2 days later.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Arteries ; Brachial Artery ; Brachiocephalic Trunk ; Consciousness ; Embolectomy ; Heart Arrest ; Humans ; Hypotension ; Lung* ; Male ; Middle Aged ; Neoplastic Cells, Circulating* ; Pneumonectomy ; Reference Values