We measured serum levels of CA-125 and Tissue polypeptide antigen(TPA) in 135 patients with pelvic tumors(129 benign pelvic tumors and 6 malignant ovarian tumors) preoperatively. Each tumor marker was measured by immunoradiometric assay. Serum CA-125 levels of 35.0U/ml, 65.0U/ml and TPA levels of 80.0U/ml, 100.0U/ml were determined as cut-off values. The results were evaluated by each tumor marker and two tumor markers coincidently. The results were as follows : (continue)
Humans ; Immunoradiometric Assay ; Biomarkers, Tumor

No abstract available.
Addison Disease*

OBJECTIVE: The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. METHODS: Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were 7.5+/-3.2 and 78.1+/-29.3 cc, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. RESULTS: None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount, midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. CONCLUSION: In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.
Brain ; Craniotomy ; Glasgow Coma Scale ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Logistic Models ; Operative Time ; Putaminal Hemorrhage ; Retrospective Studies ; Risk Factors ; Survival Rate

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.
Acute Disease ; Hernia, Diaphragmatic/*complications ; Humans ; Male ; Middle Aged ; Stomach Volvulus/diagnosis/*etiology

OBJECTIVE: The purpose of this study was to determine the normal morphometric landmarks of the uniting and dividing points of the brachial plexus (BP) in the periclavicular region to provide useful guidance in surgery of BP injuries. METHODS: A total of 20 brachial plexuses were obtained from 10 adult, formalin-fixed cadavers. Distances were measured on the basis of the Chassaignac tubercle (CT), and the most lateral margin of the BP (LMBP) crossing the superior and inferior edge of the clavicle. RESULTS: LMBP was located within 25 mm medially from the midpoint in all subjects. In the supraclavicular region, the upper trunk uniting at 21 +/- 7 mm from the CT, separating into divisions at 42 +/- 5 mm from the CT, and dividing at 19 +/- 4 mm from the LMBP crossing the superior edge of the clavicle. In the infraclavicular region, the distance from the inferior edge of the clavicle to the musculocutaneous nerve (MCN) origin was 49 +/- 1 mm, to the median nerve origin 57 +/- 7 mm, and the ulnar nerve origin 48 +/- 6 mm. From the lateral margin of the pectoralis minor to the MCN origin the distance averaged 3.3 +/- 10 mm. Mean diameter of the MCN was 4.3 +/- 1.1 mm (range, 2.5-6.0) in males (n = 6), and 3.1 +/- 1.5 mm (range, 1.6-4.0) in females (n = 4). CONCLUSION: We hope these data will aid in understanding the anatomy of the BP and in planning surgical treatment in BP injuries.
Adult ; Brachial Plexus ; Cadaver ; Clavicle ; Female ; Humans ; Male ; Median Nerve ; Musculocutaneous Nerve ; Pectoralis Muscles ; Ulnar Nerve

OBJECTIVE: Topographic arrangement and morphometric pattern of cauda equina are studied. METHODS: In 10 adult formalin fixed cadavers, the entire dural sac of lumbosacral spine including extradural nerve roots was extracted. After paraffin fixation, serial cross section from sacral nerve roots to conus medullaris was performed. We investigated following structures at each disc level using a slide scanner after haematoxylin and eosin and Masson's trichrome stains: 1) location of filum terminale(FT), 2) arrangement of motor and sensory bundles, 3) morphometric characteristics of sensory bundles to motor bundle of each spinal nerve root. RESULTS: The FT was located in the dorsal half of midline at L2-3 disc level and in the most dorsal portion of midline from the L4-5 disc level and downward. All bundles of each nerve root showed an oblique arrangement. Motor bundle of each spinal nerve root was always located in the anterior or anteromedial portion of the corresponding sensory bundles. At L4-5 and L5-S1 disc levels, S1 to S4 nerve roots were arranged inverted V-shape centered FT. The sensory root was composed of several bundles whereas the motor root was always composed of a single bundle. The areas occupied by sensory bundles were larger than 2 to 4 times in S1-3 sacral nerve roots and 1.9 to 2.4 times in L3-5 lumbar nerve roots compared with those occupied by the corresponding motor roots. CONCLUSION: This study will be helpful to prevent the nerve root injury during the operation of cauda equina and predict postoperative complications.
Adult ; Cadaver ; Cauda Equina* ; Coloring Agents ; Conus Snail ; Eosine Yellowish-(YS) ; Formaldehyde ; Humans ; Paraffin ; Postoperative Complications ; Spinal Nerve Roots ; Spine

OBJECTIVE: To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). METHODS: A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. RESULTS: The anterior and middle segments of the ATPAs arose at mean intervals of 1.75+/-1.62 mm and 5.86+/-2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17+/-1.64 mm. The posterior segment arose at a mean interval of 2.43+/-1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45+/-1.39 mm. The mean numbers of perforators were 2.66+/-1.19, 3.03+/-1.84, and 1.67+/-0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. CONCLUSION: Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa.
Adult ; Arteries* ; Brain ; Cadaver ; Carotid Artery, Internal ; Crowding ; Humans ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery

OBJECTIVE: To investigate the morphometric characteristics of the pituitary gland and diaphragma sellae in Korean adults. METHODS: Using the 33 formaline fixed adult cadavers (23 male, 10 female), the measurements were taken at the diaphragma sellae and pituitary gland. The authors investigated the relationship between dura and structures surrounding pituitary gland, morphometric aspects of pituitary gland and stalk, and morphometric aspect of central opening of diaphragma sellae. RESULTS: The boundary between the lateral surface of pituitary gland and the medial wall of cavernous sinus was formed by the thin dural layer and pituitary capsule. The pituitary capsule adherent tightly to the pituitary gland was observed to continue from the diaphragma sellae. Mean width, length, and height of the pituitary gland were 14.3 +/- 2.1, 7.9 +/- 1.3, and 6.0 +/- 0.9 mm in anterior lobes, and 8.7 +/- 1.7, 2.9 +/- 1.1, and 5.8 +/- 1.0 mm in posterior lobes, respectively. Although all dimensions of anterior lobe in female were slightly larger than those in male, statistical significance was noted in only longitudinal dimension. The ratio of posterior lobe to the whole length of pituitary gland was about 27%. The mean thickness of pituitary stalk was 2 mm. The diaphragmal opening was 5 mm or more in 26 (78.8%) of 33 specimen. The opening was round in 60.6% of the specimen, and elliptical oriented in an anterior-posterior or transverse direction in 39.4%. CONCLUSION: These results provide the safe anatomical knowledge during the transsphenoidal surgery and may be helpful to access the possibility of the development of empty sella syndrome.
Adult ; Cadaver ; Cavernous Sinus ; Diaphragm ; Empty Sella Syndrome ; Female ; Formaldehyde ; Humans ; Male ; Pituitary Gland

OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.
Adult ; Cadaver ; Ganglia, Sympathetic ; Head ; Humans ; Muscles ; Ribs ; Spine ; Sympathectomy ; Thoracic Cavity ; Thoracic Vertebrae ; Thoracoscopy

OBJECTIVE: The purpose of this study is to investigate the risk factors for hematoma enlargement(HE) in the patients with spontaneous putaminal hemorrhage. METHODS: Among the 620 patients with putaminal hemorrhage admitted to our hospital during the period of 1990-2000, sixty patients(9.7%) had HE on the second computed tomographic(CT) scan at the interval of mean 38 hours after attack(range 1.8-168 hours). Clinical features and CT findings of these 60 patients with HE were compared with those of the remaining 560 patients without HE. RESULTS: Multivariate logistic regressional analysis revealed that the independent risk factors for HE were CT finding showing the separation of hematoma(odds ratio[OR] 3.5, 95% confidence interval [CI] 1.7-7.3, p=0.0006) or the hypodensity around or within hematoma(OR 2.5, 95% CI 1.2-5.6, p=0.0194), alcoholism(OR 4.8, 95% CI 2.0-11.7, p=0.0004), hematoma volume of 20-39cc(OR 2.54, 95% CI 1.0-6.3, p=0.0424), Glasgow Coma Scale(GCS) score of 8-11(OR 3.1, 95% CI 1.4-6.9, p=0.0046) and glutamic-pyruvic transaminase>50 IU/L(OR 6.54, 95% CI 2.1-20.5, p= 0.0013). CONCLUSION: Alcoholism and liver dysfunction appear to increase the risk of HE in putaminal hemorrhage. Particularly, careful observation for HE is needed in the patients who are GCS score of 8-11 at the time of admission, who have hematoma volume of 20-39cc and the CT finding showing the separation of hematoma or the hypodensity around or within hematoma.
Alcoholism ; Coma ; Hematoma ; Humans ; Liver Diseases ; Logistic Models ; Putaminal Hemorrhage* ; Risk Factors*