Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.
Hematoma ; Hematoma, Epidural, Spinal* ; Hypertension ; Ligamentum Flavum ; Neurosurgery ; Postpartum Period ; Pregnancy ; Vascular Malformations

Recently, the bcl-2 and p53 protein have been recognized as important factors that is contributed to programmed cell death. The objective of this study was to evaluate the prognostic significance of bcl-2 and p53 protein expression in uterine cervical carcinoma. The expression of bcl-2 and p53 in 59 cases of uterine cervical carcinoma (stage IB to IIB) were surgically treated from January 1993 to June 1994. The expression of bcl-2 and p53 was examined by immunohistochemical method using formalin fixed paraffin embedded tissue specimens. The 48 cases were squamous cell carcinoma and 11 cases were adenocarcinoma. The results were as follows: 1. The expression rate of bcl-2 protein was 28.8%(17/59) and there was no significant correlaltion between the expression of bcl-2 protein and the clinicopathologic parameters (histologic type, grade, FIGO stage, cervical invasion depth, lymph node metastasis, parametrial invasion, tumor size, neoadjuvant chemotherapy response, recurrence, survival). 2. The expression rate of p53 protein was 32.2%(19/59) and there was no significant correlation between expression of p53 protein and the clinicopathologic parameters. 3. There was significant correlation between and expression of bcl-2 and p53 protein (P 0.05). In conclusion, bcl-2 and p53 protein are thought to be possible factors in the carcinogenesis of uterine cervical carcinoma and correlate with progression of it. But further study will be required to clarify the role of bcl-2 and p53 in carcinogenesis of the uterine cervix.
Adenocarcinoma ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Death ; Cervix Uteri ; Drug Therapy ; Female ; Formaldehyde ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Recurrence ; Uterine Cervical Neoplasms*

BACKGROUND & OBJECTIVES:According to recent studies, Mycoplasma DNA was positive in 20% of uterine cervical cancer tissue and 48% of gastric cancer tissue. It also showed the correlation with human cancers and infection of Mycoplasma. Ureaplasma urealyticum(U. urealyticum) is a bacteria of high infection rate in women's urogenital system, but it is difficult to find a report about the relations to cancer. So, the objectives of this studies are to investigate the infection rate of the U. urealyticum from Korean women's ovarian cancer, borderline ovarian cancer and benign ovarian tumor, and to discover the relationship between these ovarian tumors with U. urealyticum's infection. METHODS: In obstetrics and gynecology department of Kosin medical college, the PCR procedure and cultivation was performed on extracted cancer tissues of 22 ovarian cancer patients and 5 borderline ovarian cancer patients who had operation, and it was also performed on 30 benign ovarian tumor patients as an control group. RESULTS: The detection freguency of U. urealyticum in ovarian cancer tissue was 31.8% (7/22) which was higher than 13.3% (4/30) of benign ovarian tumor but had no statistical relation (p=0.318). In borderline ovarian cancer, the detection frequency was 0.0% (0/5). The infection frequency of U. urealyticum was 22.7% (5/22) in ovarian cancer tissue and 0.0% (0/5) in borderline ovarian tumor and 3.3% (1/30) in benign ovarian tumor, so the infection frequency was higher in ovarian cancer tissue than benign ovarian tumor which was showing statistical relation (p=0.024). The detection frequency of U. urealyticum from benign ovarian tumor tissue was 23.0% (3/13) in mature teratoma and 16.7% (1/6) in epithelial ovarian tumor, which was showing higher frequency in mature teratoma but had no statistical relation(p=0.589). The infection frequency was showed only in epithelial ovarian tumor as 16.7% (1/6) but also had no statistical relation(p=0.388). The detection frequency of U. urealyticum followed by the FIGO stage of malignant ovarian cancer was 33% in stage I and 30.8% (4/13) in stage III, which was higher in stage I but had no statistical relation(p=0.662). The infection frequency was 11.1% (1/9) in stage I and 30.8% (4/13) in stage III, which was higher in stage III but had no statistical relation(p=0.360). CONCLUSION: With the above results, there was no significant relation between U. urealyticum infection and ovarian cancer. There is, however, few study and case on ovarian cancer internally and externally. It is considered that more studies on the subject with much cases should be made.
Bacteria ; DNA ; Gynecology ; Humans ; Mycoplasma ; Obstetrics ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Stomach Neoplasms ; Teratoma ; Ureaplasma urealyticum* ; Ureaplasma* ; Urogenital System ; Uterine Cervical Neoplasms

Blood transfusion is indicated the surgical patient to maintain circulating blood volume, provide adequate oxygenation, and maintain clotting factor levels. Anesthesiologists should known the time and vloume of blood transfusion in order to carry out transfusion effectively. We measure the amount of transfused blood and plasma expander used during general or spinal anesthesia surgery for four years(from Jan. 1977 to Dec. 1980) and obtained the following results. The total amounts of transfused blood were 6563 pints and those of plasma expander were 1769 bottles. The compansated amounts to blood loss were average 1044 ml in each case. The amounts of transfused blood used in each surgical dept. were different. The thoracic surgery department used the most averaging 4.76 pints and least in urologic dept. at 1.48 pints. The number of operations increased year after year but the average amount of transfused blood showed a decreasing tendency and that of plasma expander showed increasing tendency. The average compensated amounts for blood loss among the following operations were 831ml in a hysterectomy, 1089ml in a nephrectomy, 2244ml in a lobectomy, 1165ml in a craniotomy and 1313ml in a intramedullary nailing.
Anesthesia, Spinal ; Blood Transfusion ; Blood Volume* ; Craniotomy ; Fracture Fixation, Intramedullary ; Humans ; Hysterectomy ; Nephrectomy ; Oxygen ; Plasma ; Thoracic Surgery

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.
Anesthesia, General ; Anesthesia, Local ; Diagnosis ; Dyspnea ; Hoarseness ; Polyps* ; Tracheostomy ; Tracheotomy* ; Vocal Cords

PURPOSE: Thrombocytosis is reported in patients with various tumors, including stomach, colon, ovarian, lung and pancreatic cancers. Some clinical reports have shown thrombocytosis to be a poor prognostic factor in cancer patients. However, in hepatocellular carcinoma patients, the incidence and clinical significance of thrombocytosis have not been clearly verified. In this study, the clinical significance of platelet counts was investigated in patients with hepatocellular carcinomas. METHODS: 212 patients with surgically proven hepatocellular carcinomas were enrolled in this study. The incidence, relationship with other clinicopathological factors, and the prognostic value of thrombocytosis were retrospectively evaluated. RESULTS: The incidence of thrombocytosis (> or =400, 000/ul) was 2.8% (6/212). The platelet counts were elevated in patients with a large sized tumor (p< 0.001), advanced TNM stage (p=0.009) and gross tumor thrombi in the portal vein (p=0.009). There was no difference in the survival between patients with low and high platelet counts. CONCLUSION: The incidence of thrombocytosis in hepatocellular carcinoma patients was very low. The platelet counts were elevated in patients with advanced hepatocellular carcinomas, but no prognostic significance was shown in this study.
Blood Platelets* ; Carcinoma, Hepatocellular* ; Colon ; Humans ; Incidence ; Lung ; Pancreatic Neoplasms ; Platelet Count* ; Portal Vein ; Retrospective Studies ; Stomach ; Thrombocytosis

Aneurysms arising from the ophthalmic artery itself are very rare compared with aneurysms originating from the bifurcation of the ophthalmic artery and carotid artery. There was only one reported case of a ruptured aneurysm of the ophthalmic artery itself. We discuss clinical significance of an aneurysm at this site, as well as the role of three dimentional image of multislice computed tomography angiogram(3D-image of MCTA) in determining the cause of subarachnoid hemorrhage(SAH).
Aneurysm ; Aneurysm, Ruptured* ; Carotid Arteries ; Multidetector Computed Tomography ; Ophthalmic Artery*

OBJECTIVE: The purpose of this study was to review the clinicopathologic features, recurrent rate, survival rate and controversable issues in the treatment of the ovarian malignant germ cell tumors. PATIENTS AND METHODS: From August, 1991 to November, 1998 thirty-one patients with malignant germ cell tumors of the ovary treated in the department of obstetrics and gynecology, Kosin University Medical college, were eligible and assessable. Demographic characteristics, symptoms, signs, stage, tumor grade, mode of therapy and results of follow up were reviewed retrospectively. RESULTS: The patients with malignant germ cell tumor constituted 6.37% of all ovarian malignancies during this period. Histologic subtypes were 8 dysgerminoma(25.8%), 7 endodermal sinus tumor(22.6%), 10 immature teratoma(32.3%), 3 mixed germ cell tumor(9.7%), 3 choriocarcinoma(9.7%). The age of the patients ranged from 10 to 40 years (mean +/-S.D.; 24.26 +/- 7.51). The most common symptom was abdominal pain(38.7%). Most had stageI(18 cases, 58.0%) or stageIII(5 cases, 16.2%) diseases. All patients underwent surgery as the initial treatment, and nine patients received more than one operation. Postoperative adjuvant chemotherapeutic regimens were VAC, VBP, EP, BEP, EMA, and EMA CO. The mean follow up duration was 26.0(+/- S.D.; +/- 20.3) months. The 2-year and 5-year survival rate were 91.97%(+/- S.E.; +/- 0.05) and 86.86%(+/- S.E.; +/- 0.07).
Endoderm ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary ; Retrospective Studies ; Survival Rate

In angiographic examinations, abnormalities of vertebral arteries are incidental findings because they are, in most of cases, clinically asymptomatic. We report a case of young woman with a fenestrated anomaly of the left vertebral artery with ischemic strokes. The patient was suffered from repeated attacks of transient ishemic attack(TIA) and cerebral infarction. Vertebral angiography demonstrated a fenestrated anomaly of the left vertebral artery and a large intraluminal thrombus was detected at just proximal of the fenestration. Proximal balloon occlusion of the involved vertebral artery was done and the patient became free from ischemic attack. Follow-up angiography showed well visualization of the posterior circulation through right vertebral artery and the ballooned vertebral artery was well occluded. The left posterior inferior cerebellar artery(PICA) was filled well via collateral circulation from the opposite side.
Angiography ; Balloon Occlusion ; Cerebral Infarction ; Collateral Circulation ; Female ; Follow-Up Studies ; Humans ; Incidental Findings ; Stroke* ; Thrombosis ; Vertebral Artery*