Colposcopic examination and biopsy were performed on 197 patients with abnormal cervical cytology. The patients subsequently underwent electrocoagulation, LLETZ, conization and hysterectomy depending on their diagnosis from January, 1989 to December, 1994. The comparison between the diagnosis of cytology and that of colposcopic biopsy showed fair agreement with only 35% of cases(K=20%). The abnormal lesion was underestimated by cytology in 49.7% of cases. Thirty three cases(16.8%) were threated by LLETZ. Histological comparison between the colposcopic biopsies and LLETZ samples showed fair agreement with 39% of cases (K=25%). 5 cases(15%) of the colposcopic biopsy have been underestimated when compared to the LLETZ histology. Sixty two cases were done conization after colposcopic biopsy. Histological comparison between the colposcopic biopsies and conization samples showed fair agreement with 59% of cases(K=38%). The colposcopic biopsies were underestimated in 24.2% of cases compared to the cone biopsy specimen. The correct diagnosis rates of colposcopic biopsy of dysplasia, carcinoma in situ, and microinvasive carcinoma were 70%, 82%, and 20% respectively. (continue)
Biopsy ; Carcinoma in Situ ; Conization ; Diagnosis ; Electrocoagulation ; Humans ; Hysterectomy

Postischemic functional impairment of the kidney is a severe problem following living or cadeveric renal transplantation. It is well established that a substantial component of postischemic injury is caused by oxygen free radicals generated from xanthine oxidase at ischemia/reperfusion (VR) through lipid peroxidation. Glutathione is well known as a radical scavenger of oxygen free radicals. Malonyldialdehyde (MDA) is a stable end product of lipid peroxidation. The present study was undertaken to investigate whether the measurement of levels of xanthine oxidase activity, glutathione, and MDA in renal tissue could be used as indicators of renal function following I/R injury 50 male Sprague-Dawley were divided into 3 groups; control group (N=10), allopurinol-pretreatment group (Group A, N=20) and no-pretreatment group (Group B, N=20) for in-vitro and in-vivo study. Animals in in-vitro study underwent bilateral renal ischemia for 60 min after pretreatment with allopurinol in group A and saline in group B, and left nephrectomy was then performed for study of ischemic injury. After 30 min of right renal reperfusion, right nephrectomy was then performed for VR injury study. Xanthine oxidase activity, glutathione, and MDA were measured in nephrectomized kidney tissues. In-vivo renal function studies were performed in both group A and B with measurement of creatinine clearance (Ccr) at 7th day of experiments after renal ischemia for 60 min. The xanthine oxidase activity decreased significantly in group A, but increased significantly in group B. The type conversion ratio increased significantly in group B. Glutathione levels decreased significantly in group B compared to group A. MDA levels increased significantly in group B compared to group A. Ccr decreased significantly in group B compared to group A. Thus, it is suggested that the measurement of levels of xanthine oxidase activity, glutathione, and MDA in renal tissue following ischemia/reperfusion injury could be used as indicators of renal function.
Allopurinol ; Animals ; Creatinine ; Free Radicals ; Glutathione ; Humans ; Ischemia ; Kidney ; Kidney Transplantation ; Lipid Peroxidation ; Male ; Malondialdehyde ; Nephrectomy ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Xanthine Oxidase

Cytogenetic techniques were used to detect specific chromosomal losses and / or stuctural changes in 6 meningioma cell population of 11meningioma patients. Polymorphic DNA markers were uti.lized to investigate the loss of constitutional heterozygosity on chromosomes 8. 17 and 22 in 9 meningioma cell population of 1l meningioma patients. As a result, 5 cases(M-2.4,5.9, and 10) represented 45. XX. -22 or 45, XY.-22 as stem line. In addition to chromosome 22, other chromosomes were lost randomly. In one case(M-3) normal karyotypic pattern was oberved. The 9q+ structural change was also noted in case M-2. This structural change was thought to be the chromosomal involvement secondary to the loss of chromosome 22 in meningioma. Retentions of constitutional heterozygosity on chromosomes 8 and 17 were found in all cases. Loss of constitutional hererozygosity on chromosome 22 were found at Hind m RFLP of v-sis in cases M-1 and M-7. EcoRI RFLP of v-sis in case M-1. Bgl II RFLP of v-sis case M-1. Xba I RFLP of v-sis in cases M-6. M-9 and M-11. And EcoRI RFLP of bcr in all cases. Rearrangement of chromosome 22 in case M-1 was detected on the Xba I RFLP of v-sis as extra band(3.14kb). The reduction to hemizygosity on chromosome 22 was one important step in tumorigenesis of meningioma. Monosomy 22 might operate at the primary level of tumor initiation. Random losses of other chromosomes or structural changes as 9q+ were postula!ed to be related to tumor development.
Carcinogenesis ; Chromosomes, Human, Pair 22 ; Cytogenetic Analysis ; Cytogenetics* ; Genetic Markers ; Humans* ; Meningioma* ; Monosomy ; Polymorphism, Restriction Fragment Length

Although the occurrence of fatal pulmonary embolism may be diminishing, it still accounts for a substantial proportion of postoperative deaths in the middle-aged and older persons, especially among those undergoing major orthopedic surgery, despite improvements in patient management. We experienced cardiac arrest during bipolar endoprosthesis. Cardiopulmonary resuscitation was started and the transesophageal echocardiogram showed right heart failure. We suspected acute pulmonary thromboembolism and decided to perform thromboembolectomy with cardiopulmonary bypass. A massive old blood clot and a 1.0 x 1.5 cm thrombus were removed from both pulmonary arteries. However, despite massive fluid therapy and the use of inotropic agent, the patient failed to recover successfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Fluid Therapy ; Heart Arrest ; Heart Failure ; Hip* ; Humans ; Intensive Care Units ; Orthopedics ; Pulmonary Artery ; Pulmonary Embolism* ; Thrombosis

Recently, laser treatment of benign prostatic hyperplasia (BPH) is considered as a promising alternative to traditional transurethral resection of the prostate (TURP). To evaluate the effectiveness and safety of laser therapy on BPH, we compared the results of transurethral balloon laser thermotherapy (TUBALT, n=13) and Hybrid laser prostatectomy (HLP, n=21) with those of TURP (n=25) in 58 patients with mild and moderate BPH. Following data were evaluated at postoperative 1, 3 and 6 months : AUA symptom score (SS), maximal flow rate (Qmax), subjective symptom improvement (SI), postoperative complications. All 3 groups show significant improvement after treatment in the Qmax values. Among 3 groups, the Qmax value was lower in TUBALT group (12.9+/-3.3 ml/sec) than those in HLP group (15.5+/-5.2 ml/sec) and TURP group (18.7+/-5.3 ml/sec) on postoperative 6 months. The Qmax values were not significantly different between HLP and TURP groups. In the SS values, all 3 groups show significant improvement after treatment and, TUBALT (9.9+/-9.7) and HLP (10.3+/-9.4) group were comparable to TURP group (5.2+/-4.2) on postoperative 6 months. In global assessment of SI, both HLP (87.5%) and TUBALT (75%) group were also comparable to TURP (90%) group on postoperative 3 months. but TUBALT group showed delayed symptom improvement compared to TURP group. Postoperative complications were minimal both in HLP and TUBALT groups, compared to TURP group. These results suggest that both HLP and TUBALT are effective in mild and moderate BPH, Further more, HLP treatment could be considered a promising alternative to TURP.
Humans ; Hyperthermia, Induced* ; Laser Therapy ; Postoperative Complications ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

BACKGROUND: The purpose of this study was to compare the incidence of postoperative nausea and vomiting (PONV) in patients undergoing major gynecologic surgery with those undergoing Cesarean-section during intravenous patient-controlled analgesia (PCA). METHODS: Seventy two patients received general anesthesia with enflurane. Group 1 patients underwent major gynecologic surgery, and group 2 patients were parturients who underwent Cesarean-section. Postoperatively, fentanyl was continuously infused i.v. using Accufuser PLUS (basal, 2 ml/h; bolus, 0.5 ml; lockout interval, 15 min) containing fentanyl 25microgram/kg in saline. PONV was evaluated at 6, 12, 24 and 36 h after starting continuous infusion and compared in the two groups. RESULTS: The incidence of PONV was significantly lower in group 2 (14%) than in group 1 (67%) (P < 5). CONCLUSIONS: Our results show that the incidence of PONV was lower for Cesarean-section than for gynecologic surgery.
Analgesia, Patient-Controlled* ; Anesthesia, General ; Enflurane ; Female ; Fentanyl* ; Gynecologic Surgical Procedures* ; Humans ; Incidence ; Postoperative Nausea and Vomiting*

A 67-year-old woman was admitted to our hospital under suspicion of a hepatic tumor, which had been previously diagnosed to be an adenocarcinoma by fine needle aspiration. Computed tomography and magnetic resonance imaging revealed a large tumor measuring 9 cm in diameter in Couinaud's hepatic segments 4, 5, and 8. We diagnosed the patient to have primary liver cancer, and suspected intrahepatic cholangiocarcinoma preoperatively. We performed a central hepatectomy. According to the immunohistochemical findings of the resected specimen, the tumor was diagnosed to be a primary neuroendocrine carcinoma in the liver. The patient is presently alive without recurrence at 3 months after hepatic resection.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Neuroendocrine ; Cholangiocarcinoma ; Chromogranin A ; Female ; Hepatectomy ; Humans ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Recurrence

We analyzed the practical problems and factors which affect making the correct differential diagnosis in the interpretation or test results from the nocturnal penile tumescence (NPT) test and erotic stimulation test (EST). This was done to provide better information for higher diagnostic accuracy in the clinical application of these tests. The followings are the results of NPT tests and EST identifying the factors affecting correct differential diagnosis by comparison the other differential diagnostic methods. The overall sensitivity of NPT test (Number: 114 total patients) was 82%. 21 cases (18%) could not be diagnosed correctly due to traction of the sensor (12 cases, 10%) and sleep disturbance (9 cases, 8%). The overall sensitivity of EST (Number: 174 total patients) without considering the degree of patient`s sexual drive to erotic stimulation was 77%. 40 cases (23%) could not be diagnosed correctly due to tolerance to pornographic film (17 cases, 10 %), discomfort by the body attachments (14 cases, 8%) and traction of the sensor (9 cases, 5%). However, higher sensitivity (90%) and lower rate of incorrect diagnosis (10% ) were observed in 119 patients who showed Grade II or III (moderate to good) sexual drive to erotic stimulation. The results suggest that undesirable factors in the primary screening methods, traction of sensor, sleep disturbance in NPT test, and tolerance to pornographic film, discomfort by the body attachments, traction of sensor in EST must be taken into consideration when interpretation of test results is being performed.
Diagnosis ; Diagnosis, Differential ; Diagnostic Tests, Routine* ; Erectile Dysfunction* ; Humans ; Male ; Mass Screening ; Penile Erection ; Traction

BACKGROUND: Pleural effusion is one of most common clinical mainifestations associated with a variety of pulmonary disease such as malignancy, tuberculosis, and pneumonia. However, there are no useful laboratory tests to determine the specific cause of pleural effusion. Therefore, an attempt was made to analyze the various types of pleural effusion and search for useful laboratory tests for pleural effusion in order to differentiate between the disease, especially between a malignant pleural effusion and a non-malignant pleural effusion. METHODS: 93 patients with a pleural effusion, who visited the Severance hospital from January 1998 to August 1999, were enrolled in this study. Ultrasound-guided thoracentesis was done and a confirmational diagnosis was made by a gram stain, bacterial culture, Ziehl-Neelsen stain, a mycobacterial culture, a pleural biopsy and cytology. RESULTS: The male to female ratio was 56:37 and the average age was 47.1±21.8 years. There were 16 cases with a malignant effusion, 12 cases with a para-malignant effusion, 36 cases with tuberculosis, 22 cases with a para-pneumonic effusion, and 7 cases with transudate. The LDH2 fraction was significantly higher in the para-malignant effusion group compared to the para-pneumonic effusion group [30.6±64.% and 20.2±7.5%, respectively (p<0.05)] and both the LDH and LDH2 fraction was significantly in the para-malignant effusion group compared to those with tuberculosis [16.4±7.2% vs. 7.6±4.7%, and 30.6±6.4% vs. 17.6±6.3% respectively (p<0.05)]. The pleural effusion/serum LDH4 fraction ratio was significantly lower in the malignant effusion group compared to those with tuberculosis [1.5±0.8 vs. 2.1±0.6, respectively (p<0.05)]. The LDH4 fraction and the pleural effusion/serum LDH4 fraction ratio was significantly lower in the para-malignant effusion group compared to those with tuberculosis [17.0±5.8% vs. 23.5±4.6% and 1.3±0.4 vs. 2.1±0.6, respectively(p<0.05)]. CONCLUSION: These results suggest that the LDH isoenzyme was the only useful biochemical test for a differential diagnosis of the various disease. In particular, the most useful test was the pleural effusion/serum LDH4 fraction ratio to distinguish between a para-malignant effusion and a tuberculous effusion.
Biopsy ; Diagnosis ; Diagnosis, Differential* ; Exudates and Transudates ; Female ; Humans ; Lung Diseases ; Male ; Pleural Effusion* ; Pleural Effusion, Malignant ; Pneumonia ; Tuberculosis

BACKGROUND: Monitored anesthesia care (MAC) has become increasingly important as a means of ensuring patient comfort, safety and satisfaction during surgery under local anesthesia. The purpose of this study was to evaluate the effect of monitored anesthesia care using alfentanil and ketorolac in patients undergoing endoscopic sinus surgery (ESS). METHODS: We studied 47 adult patients premedicated with glycopyrrolate 0.2 mg and midazolam 0.02 mg/kg IV. Using a 5.0 endotracheal tube, 5 L/min of oxygen was delivered via mouth. A mixture of 30 mg of ketorolac and 2,500microgram of alfentanil in 25 ml of saline was infused to patients at a rate of 1microgram/kg/min alfentanil after a bolus injection of 5microgram/kg alfentanil before operation. During operations we monitered vital signs, SpO2, OAA/S (Observer's Assessment of Alertness/Sedation) scale and BIS scores. Six hours postoperatively we assessed patient degree of satisfaction via NRS (1-10) with the anesthetic technique and side effects. RESULTS: Mean duration of drug infusion was 35 +/- 10.1 min, and the mean infusion rate of alfentanil was 1.09 +/- 0.23microgram/kg/min. Significant differences were observed between OAA/S scale scores at 10 min and 30 min after drug infusion and those in the waiting room (4.63, 4.65 vs 5, P <0.05)(Fig. 4). The mean patient satisfaction score was 8.3 out of 10, and 93.6% (44/47) of patients said they would recommend this anesthetic technique to others for ESS. CONCLUSIONS: Our results suggest that MAC using a mixture of alfentanil and ketorolac during ESS is a good way of relieving patient anxiety and pain without respiratory depression or excessive sedation. This study also showed a high level of patient satisfaction for those undergoing ESS under local anesthesia.
Adult ; Alfentanil* ; Anesthesia* ; Anesthesia, Local ; Anxiety ; Glycopyrrolate ; Humans ; Ketorolac* ; Midazolam ; Mouth ; Oxygen ; Patient Satisfaction ; Respiratory Insufficiency ; Vital Signs