No abstract available.
Drug Therapy* ; Humans ; Uterine Cervical Neoplasms*

OBJECTIVES: The diagnosis of ASCUS(atypical squamous cells of undetermined significance) and LSIL(low-grade squamous intraepithelial lesion) was introduced in 1988 by the Bethesda system for reporting cervical/vaginal cytologies. A significant proportion of women referred for colposcopy with low grade cervical cytologic abnormalities(ASCUS and LSIL) will have high grade cervical intraepithelial neoplasia(CIN II or CIN III) and therefore require adequate management. The purposes of this study were to evaluate the usefulness of high risk type HPV(human papillomavirus) DNA detection using PCR(polyerase chain reaction) in patients with low grade cervical cytologic abnormalities in the prediction of high grade CIN and invasive cancer and to determine the clinical triage in the management of low grade cervical cytologic abnormalities. METHODS: We reviewed 18,942 cases of Papanicolau smears that were performed at our hospital from Jan. 1995 to Mar. 1999. Colposcopically directed biopsy or LLETZ(large loop excision of transformation zone) or hysterectomy were performed on 318 patients with abnormal PAP smears of low degree. HPV PCR testing of high risk types(16 and 18) was also performed on 115 patients. RESULTS: Histologic outcome of ASCUS included 43 cases(38.4%) of high grade CIN and invasive cancer, and that of LSIL included 65 cases(47.5%) of high grade CIN and invasive cancer. In cases of high risk HPV type, 19 patients(73.1%) were at age over 30 years. A highly significant correlation was found between a positive test for high risk types of HPV and finding of high grade CIN and invasive cancer. Among 51 women with ASCUS, a positive test for high risk type had a sensitivity and specificity of 40.0% and 86.1%, and positive predictive value(PPV) and negative predictive value(NPV) of 54.5% and 77.5%, respectively. In 64 women with LSIL, a positive high risk type test was associated with sensitivity and specificity of 30.0% and 94.1%, and PPV and NPV of 81.8% and 60.4%, respectively. CONCLUSION: Our results suggest that high risk type HPV may be positively predictive of and may act as a surrogate marker for high grade CIN and invasive cancer in women with low grade cervical cytologic abnormalities. The management of women with a low grade cervical cytologic abnormalities should be active such as colposcopically directed biopsies.
Biomarkers ; Biopsy ; Colposcopy ; Diagnosis ; DNA* ; Female ; Humans* ; Hysterectomy ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage

Polyamines are closely related to cell growth and differentiation and increased levels of urine polyamines (UPs) has been reported in various human cancers. However, there were few reports on changes of UPs in patients with cervical carcinoma. We investigated the clinical utility of UPs as well as serum squamous cell carcinoma (SCC) antigen in cervical carcinoma. The association of pretreatment SCC antigen and UPs with clinicopathologic parameters was assessed in 478 patients with cervical carcinoma. SCC antigen was measured by radioimmunoassay and UPs by enzymatic assay method. The prognostic significance of pretreatment SCC antigen and UPs, and the relationship between pretreatment and posttreatment SCC antigen and UPs according to treatment modalities were analyzed. There was a trend of increased level of UPs with cancer progression, whereas significant difference of SCC antigen value was found with cancer progression. Among various clinicopathologic parameters, tumor size and macroscopic lymph node metastasis were associated with pretreatment SCC antigen and UPs level as well. Increased pretreatment SCC antigen level (>2.0ng/ml) and UPs level (>45 micromol/g creatinine) had significant impact on survival. Multivariate analysis revealed that pretreatment SCC antigen, lymph node metastasis and tumor size were independent prognostic factors on survival in the same stage patients. SCC antigen levels decreased after radiotherapy and neoadjuvant chemotherapy. In patients treated by radiation, response status was associated with postradiation SCC antigen, which showed a good correlation with survivals. UPs positivity and SCC antigen positivity in 42 recurrent cervical cancers were 64.7% and 57.9%, respectively. Pretreatment SCC antigen, combination of SCC antigen and UPs, tumor size, macroscopic lymph node metastasis and invasion depth were correlated with recurrent or residual cervical carcinoma. In conclusion, UPs together with SCC antigen may be used to assess the extent of disease status and to define the prognosis in cervical carcinoma.
Carcinoma, Squamous Cell* ; Drug Therapy ; Enzyme Assays ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Polyamines* ; Prognosis ; Radioimmunoassay ; Radiotherapy

OBJECTIVE: The aim of this study was to identify human papilloma virus(HPV) infection in cervical lesions by using polymerase chain reaction in situ hybridization(PCR-ISH) and to compare the results of PCR-ISH with conventional in situ hybridization(ISH) METHODS: Forty-seven randomly chosen neutral-buffered formalhyde-fixed cervical biopsies in which cervical intraepithelial neoplasia and invasive cervical cancer had been diagnosed were tested for HPV DNA by PCR-ISH and ISH. The method of PCR-ISH includes deparaffinization of specimens, PCR amplification of DNA, in situ hybridization and detection of amplified products. RESULTS: The positivity rate of ISH was 36% for all biopsies and 26%, 40% for CIN and invasive cancer respectively. By using PCR-ISH the positivity was 80%, 84% respectively. All PCR-ISH positive cases were ISH positive and no ISH positive was PCR-ISH negative. CONCLUSION: In our study HPV DNA, undetectable by standard in situ hybridization, was detectable by PCR in situ hybridization. Our study shows that PCR in situ hybridization is highly sensitive method for detection of HPV in cervical neoplastic specimens with morphological evidence.
Adenomyosis ; Biopsy ; Cervical Intraepithelial Neoplasia ; DNA ; Endometriosis ; Female ; Humans ; In Situ Hybridization* ; Papilloma ; Polymerase Chain Reaction* ; Uterine Cervical Neoplasms

The pathologic features of acute corrosive esophago-gastritis by ingestion of "Trapunc", a common commercial drain cleansing liquid, is presented. A 37-year-old woman ingested abut 30 ml of Trapunc (3 gm NaOH/100 ml) to commit suicide and received piecemeal esophagectomy and total gastrectomy 9 days after the episode. The esophagus and stomach were extremely friable and necrotic. The most part of the stomach showed acute toxic necrotizing gastritis which was manifested by extensive greenish brown discoloration due to liquefaction necrosis of the mucosa except for a few rugae along the greater curvature. The antrum and distal body revealed severe mucosal detachment and even transmural necrosis. The tissue reaction was basically the same as those of NaOH-induced corrosive esophago-gastritis of acute stage, although it appeared to be severer probably due to sodium hypochlorite, and additive constituent of the ingested cleanser. A unique distribution pattenr of mucosal involvement is discussed.
Female ; Humans

Prosthetic replacement was performed in 31 patients (32 cases) with femoral neck fractures at National Medical Center from 1968 to 1981. We reviewed the records of 28 patients having Austin-Moore prosthetic arthroplasty in 29 cases, and of 3 patients having Thompson prosthetic arthroplasty; then obtained following results. l. Of the 31 patients, 23 were female and 8 were male. The left hip was involved in 20 patients, right in 10, and the both sides in one. 2. The age range was between 35 and 84 years, with the average age of 61.2 years. 74.2% of patients were older than 51 years of age. 3. The most common cause of fracture was slipping or fall (65.6%), and the fracture sites were subcapital in 11 (34.4%), transcervical in 12 (37.4%), and basilar in 3 (9.4%). 4. Three cases (9.4%) were operated within a week, and 21 cases (65.6%) more than 3 weeks after injury. Good results were obtained in fresh fracture which was operated within a week. 5. In comparing the blood loss in Moores and modified Gibson's surgical approaches, the average total loss by the former was 1,290 ml and 1,720 ml by the latter. 6. In complications, one case of fracture of the posterior rim of acetabulum with subsequent subluxation and two cases of fracture of the greater trochanter were notable as operative complicatiens. 7. In a follow-up study averaging 13.1 months, good to excellent results were obtained in 8 cases, fair in 6, poor or bad in 5, respectively.
Acetabulum ; Arthroplasty ; Female ; Femoral Neck Fractures ; Femur ; Femur Head ; Follow-Up Studies ; Hip ; Humans ; Male

The widespread uae of colposcopy in the evaluation of abnormal cervical cytology has been accompanied by a trend toward decreased utilization of Papanicolaou smears and cone biopsy. But its accuracy is dependent on the criteria determining its limitations and the observer's experience. This study was performed to evaluate the diagnostic accuracy of Papanicolaau smear and eolposcopic finding and to campare these findinga with thase af colposcopically directed biopsy, conization and hysteretomy and to determine the value of endocervical curettage. Nine hundred twenty six patients were evaluated from Jan. 1, 1986 to Dec. 31, 1993 at the cancer detectinn center of the department of obstetrics and gynecology, Yonsei University, College of Medicine. Three major classes were involved in this study ; 662 cases with within normal limit Papanicolaou amears with cervical examination grossly suspicious for cancer, 187 cases with squamous intraepithelial lesion or greater, and 72 caees with reactiue or reparative change. The patients with inveaive rnalignancies of the cervix visihle to the naked eye were not included in this study. The majority of patients(75%) were 31 to 50 years of her age. The colposcopic examination wee deemed unsatisfactory in 45 cases in whom the upper limit, of the transformation zone could not be visualized. There were 881 cases each with a satisfactory colposcopie examination. We obtained the following results. In the satisfactory group with within normal limit Pap smears which had clinical impression of gross suspicion for cancer, 54 of 662 cases(8%) were diagnosed as more than cervical intraepithelial neoplasia I and 36(5.5%) were diagnosed as more than cervical intraepithelial neoplasia II with the histology of colposcopically directed biopsy. The analysis of the diagnostic values of Pap smears for cervical cancer screening showed that the sensitivity was 80.0%, the specificity was 93.8%, the false negative rate was 80.0%, the false positive rate was 15.2%, the negative predicitive value was 92.1%, and the positive predicitive value was 83.6%. In the satisfactory group with within normal limit Pap smears which had clinical impression of gross suspicion for cancer, 54 of 662 cases(8%) were diagnosed as more than CIN I and 36(5.5%) were diagnosed as more than CIN III with the histolgy of colposcopically directed biopsy. The accuracy of colposcopic impression when compared to histology of the colposcopically directed biopsy in the satisfactory group was 89.8% (within 1histologic degree) and 82.7% (precise agreement). Histologic comparision of colposcopically directed biopsy and final surgical specimen showed accuracy of 87.2% (within 1 histologic degree) and 66.5% (precise agreement). The accuracy of endocervical curettage with colposcopically directed biopsy when compared with final surgical specimen in unsatisfactory group was 82.2% (with 1 histologic degree) and 57.7% (precise agreement). In conclusion, satisfactory colposcopic evaluation in conjuction with Pap smear offers accurate method for cervical cancer detection. But endocervical curettage with colposcopically directed biopsy appears to be of less value in unsatisfactory group. Therefore futher evaluation is need.
Biopsy ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Colposcopy* ; Conization ; Curettage ; Female ; Gynecology ; Humans ; Mass Screening ; Obstetrics ; Papanicolaou Test ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*

The authors report a xase of primary non-gestational choriocarcinoma(PNGCO) of the ovary in a prepubertal female patient and reviewed. It is an extremely rere disease of which incidence is one in 369 million. Major clinical symptom is abdominal pain, precociois puberty and it can be misdiagneosed as ectopic pergnancy. Distinction from gestational choriocarcinoma(GCO) of the ovary is important because of the worse prognosis of PNGCO. But no distinctive ultrastructural or immunohistochemical differences are found between PNGCO and GCO. Most acceptable treatment modality is an aggressive surgical therapy and systemic chemotherapy, but its progrosis is poor.
Abdominal Pain ; Adolescent ; Choriocarcinoma, Non-gestational* ; Drug Therapy ; Female ; Humans ; Incidence ; Ovary* ; Prognosis ; Puberty

A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.
Arthrography ; Arthroscopy ; Diagnosis, Differential ; Female ; Head* ; Humans ; Middle Aged ; Radiography ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Tendinopathy*

No abstract available.
Fibrosis* ; Recurrence*