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

It is well known that general anesthesia and surgery cause acute depression of renal function. Also, the occurrence of frank bleeding from the urinary tract can form a blood clot which may block an indwelling catheter or even a normal urethra with development of urinary infection. Many studies have reported that prophylactic use of hypertonic mannitol will prevent acute functional renal impairement during general anesthesia and surgery, and reduce the incidence of clot formation and acute pyelonephritis. We believe that diuresis itself is a reneprotective mechanism and polyuria may yield two other advantages; 1. Fewer plugged catheters by decreasing the incidence of clots. 2. Decreased incidence of acute pyelonephritis by preventing stasis and washing out bacteria. since 1972, in our hospital, 100cc or 200cc of 20% mannitol was used for increasing the urine output during operation of urinary stone in 33 patients, We have shown that the prognosis of patients was good.
Anesthesia, General ; Bacteria ; Catheters ; Catheters, Indwelling ; Depression ; Diuresis ; Hemorrhage ; Humans ; Incidence ; Mannitol* ; Polyuria ; Prognosis ; Pyelonephritis ; Urethra ; Urinary Calculi ; Urinary Tract

There is the trend of increasing number of outpatients who are requiring surgical intervention because of medical insurance and general improvement of economic state. Ambulatory surgical clinics are prospering in the United States. Thus we have analyzed 1957 cases of outpatient anesthesia excluding local infiltration performed by surgeons from total of 4302 cases o fout patient surgery during the 5 year period between 1975 and 1979. The results of this analysis were as follows: 1) Ketamine IM or IV was used as a sole agent in 500 cases who were under 12 years of age and mean operation and recovery time were 19.95 and 58. 45 minutes, respectively. 2) Mean operation and recovery time for 1,125 cases of pentothal+N2O+O2, anesthesia were 15. 55 and 108. 23 minutes, respectively. 3) For 321 cases of halothane+N2O+O2, anesthesia, mean operation and recovery time were 40.67 and 145. 94 minutes, respectively. 4) During recovery period there were no serious complications or mortality. 5) The majority of 1,125 among 1,957cases were gynecological outpatients and the rest were distributed among the surgical departments and dermatology, 6) Pentothal, nitrous oxide, halothane and ketamine were used safely for the outpatient anesthesia according to our experiences.
Anesthesia* ; Clinical Study* ; Dermatology ; Halothane ; Humans ; Insurance ; Ketamine ; Mortality ; Nitrous Oxide ; Outpatients ; Surgeons ; Thiopental ; United States

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.
Adult* ; Blood Circulation ; Blood Pressure ; Blood Vessels ; Extremities ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Lower Extremity* ; Muscles ; Orthopedics ; Plastics ; Potassium

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

A 13-year-old male developed cardiac arrest and pulmonary edema during an elective surgery for chronic mastoiditis following a local injection of 0. 1 ml of 1: 1000 adrenaline under general anesthesia. After several days, 14-year-old male developed same episode during tonsillectomy under local anesthesia at ENT out patient department. They showed an immediate and favorable response to treatment with CPPB, rapid digitalization, fluid therapy, etc. The clinical course and pathophysiology of adrenaline induced pulmonary edema will be discussed.
Adolescent ; Anesthesia, General ; Anesthesia, Local ; Epinephrine* ; Fluid Therapy ; Heart Arrest ; Heart Arrest, Induced* ; Humans ; Male ; Mastoid ; Mastoiditis ; Pulmonary Edema* ; Tonsillectomy

No abstract available.
Astrocytoma* ; Encephalitis, Herpes Simplex* ; Herpes Simplex*

BACKGROUND: An important metabolic feature of acromegaly is a reduced action of insulin on hepatic gluconeogenesis and peripheral glucose disposal which mediated by growth hormone hypersecretion. Octreotide, a synthetic octapeptide somatostatin analogue exerts complex effects on hormonal and metabolic regulations affecting glucose homeostasis. This study was designed to ascertain the shorterm effect of octreotide on glucose tolerance in acromegaly. METHODS: 10 patients (five men and five women, age 47.9+/-11.8) were injected subcutaneously with octreotide, 100 micrograms for 24 hours. Patients were assessed with respect to growth hormone, glucose, and insulin response to a standard 100 g oral glucose tolerance test (OGTT) before and during the last 2 hour of octreotide infusion. RESULTS: During the therapy, there was significant decrease in mean blood glucose response to OGTT (678.4+/-51.9 vs 581.9+/-47.3 mg/dL/2hr: mean areas under the glucose curve, p=0.01) and mean serum insulin response to oral glucose load was significantly reduced in all patients (339.2+/-106.2 vs 256.7+/-111.3 U/mL/2hr: mean areas under the insulin curve, p=0.01). Using glucose tolerance test criteria three patients of 10 had normal glucose tolerance, four and three had impaired glucose tolerance and diabetes, respectively, at base line. While on octreotide these composition was changed to six patients of NGT, three of IGT and one diabetes. CONCLUSION: We conclude that insulin resistance mediated by GH hypersecretion was improved by shorterm octreotide treatment.
Acromegaly* ; Blood Glucose ; Female ; Gluconeogenesis ; Glucose Tolerance Test ; Glucose* ; Growth Hormone ; Homeostasis ; Humans ; Infusions, Subcutaneous* ; Insulin ; Insulin Resistance ; Male ; Octreotide* ; Social Control, Formal ; Somatostatin

Primary mediastinal nonseminomatous germ cell tumor is extremely rare. Apart from rarity and large size, mediastinal germ cell tumors show striking similarity to testicular tumors in age, incidence, and tumor type. The symptoms associated with these tumors are related mainly to size, invasion of neighboring structures, and distant metastases. Tissue diagnosis is obtained by biopsy of the primary lesion or by biopsy of metastatic sites. Tumors often present with advanced bulky disease, which are unresectable. So these tumors require an aggressive multidisciplinary approach to management. Optimal management includes aggressive surgical debulking and early use of cisplatin-bleomycin-based combination chemotherapy. Serial biomarker measurements permit early recognition of recurrence and improved timing of surgical intervention. The prognosis for mediastinal germ cell tumors is poor, not only because they are far advanced at the time of diagnosis but also because some of the tumors-such as embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors-are very aggressive. In these cases, we present three young male patients with large mass on anterior mediastinum. Tissue diagnosis was obtained by primary lesion biopsy. All patients received surgical debulking and combination chemotherapy and experienced a brief response and eventually had relapses. We report these cases with a review of literatures.
Biopsy ; Carcinoma, Embryonal ; Choriocarcinoma ; Diagnosis ; Drug Therapy, Combination ; Endoderm ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Incidence ; Male ; Mediastinum ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal* ; Pregnancy ; Prognosis ; Recurrence ; Strikes, Employee ; Testicular Neoplasms