OBJECTIVE: This study seeks to define the expression of epidermal growth factor(EGF) and transforming growth factor(TGF)-alpha and epidermal growth factor receptor(EGFR), and the relationship to the tumor progression of human cervical epithelial neoplasia. METHODS: To confirm the expression of EGF, TGF-alpha and EGFR immunohistochemically in normal cervix, cervical intraepithelial neoplasms and cervical carcinomas, we used monoclonal antibodies to EGF, TGF-alpha and EGFR. RESULTS: Immunohistochemical stainings using anti-EGF, anti-TGF-alpha and anti-EGFR antibodies showed weak or moderate stainings in all cases. Normal and CIN cases showed predominantly basal and parabasal expression of EGF, TGF-alpha and EGFR, and its expression decreased as the cells became increasingly differentiated toward the surface of the epithelium. In the cervical carcinoma EGF and TGF-alpha expressed weakly to moderately focally, and EGFR expressed intensely in all malignant cells. CONCLUSION: These results suggest that EGF, TGF-alpha and EGFR may involved in cellular proliferation of cervical squamous epithelium and have a significant role in the progression of cervical cancer.
Antibodies ; Antibodies, Monoclonal ; Cell Proliferation ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Epidermal Growth Factor* ; Epithelium ; Female ; Humans ; Receptor, Epidermal Growth Factor* ; Transforming Growth Factor alpha ; Uterine Cervical Neoplasms

OBJECTIVE: The incidence of ectopic pregnancy is increasing recently. To establish the quick and accurate diagnosis of ectopic pregnancy, we reviewed and analyzed the cases during recent 5 years. METHODS: Study datas was acquired from the 448 cases of the ectopic pregnancies who were managed and confirmed histopathologically at the our hospital from Jan. 1 1995 to Dec. 31 1999. RESULTS: The incidence of ectopic pregnancy was 1 in 20 deliveries. The most common age group was 26-30 years of age(34.4%). A previous history of abdominal or pelvic surgery was in 42.1% and tubal sterilization was in 14.1%, pelvic inflammatory disease was in 8.3%. Hemoglobin value over 10.0 gm/dl was in 79.2% and below 8.0 gm/dl in 4.5%. Initial systolic blood pressure risen above 100mmHg was in 79.0%. The most frequent intervals between last menstrual period and the onset of symptom was 6~8 weeks in 56.0%. The clinical manifestations were appeared in 78.8% from the last menstrual period to the next 4~8 weeks. In clinical symptoms, amenorrhea was encountered in 91.7%, lower abdominal pain in 88.3% and vaginal spotting in 47.3%. Ectopic gestation was implanted on the fallopian tube in 97.1%, the ovary in 1.1%, the cervix in 0.7%, the intraabdominal in 0.9% and 1 case was intramural pregnancy. Total amount of intraperitoneal hemorrhage between 100-999ml was in 59.5%, above 1,000ml in 37.5% and less than 100 ml in 3.0%. Of total 448 cases, laparotomy was done in 229 cases(51.0%) and pelvisopic surgery in 219 cases(49.0%). The mean hospital stay was 3.1 days in pelviscopy procedure and 5.0 days in laparotomy. The operative precedures were salpingectomy in 87.5%, salpingo-oophorectomy in 4.9%, cornual resection in 6.3%, ovarian wedge resection in 0.7%, and oophorectomy in 0.2%. There was no dead case in all ectopic pregnancy. Average admission period after laparoscopy was 3.1 day and after laparotomy was 5.0 day. CONCLUSION: The cognizing of increasing incidence of ectopic pregnancy, early diagnosis and early treatment is presumed to decrease mortality and increase fertility. The successful treatment and decision is a challenge to the clinician who must consider the patient's needs with appropriate tactfulness.
Abdominal Pain ; Amenorrhea ; Blood Pressure ; Cervix Uteri ; Diagnosis ; Early Diagnosis ; Fallopian Tubes ; Female ; Fertility ; Hemorrhage ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Length of Stay ; Metrorrhagia ; Mortality ; Ovariectomy ; Ovary ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Salpingectomy ; Sterilization, Tubal

PURPOSE: We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs). MATERIALS AND METHODS: From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes. RESULTS: The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8). CONCLUSIONS: The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.
Carcinoma, Renal Cell* ; Cohort Studies ; Demography ; Follow-Up Studies ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Ischemia ; Kidney Neoplasms ; Korea ; Nephrectomy* ; Outcome Assessment (Health Care)

PURPOSE: We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs). MATERIALS AND METHODS: From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes. RESULTS: The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8). CONCLUSIONS: The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.
Carcinoma, Renal Cell* ; Cohort Studies ; Demography ; Follow-Up Studies ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Ischemia ; Kidney Neoplasms ; Korea ; Nephrectomy* ; Outcome Assessment (Health Care)

Purpose: Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. Materials and methods: We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. Results: The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. Conclusions The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Background: The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. Results: Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). Conclusion NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Background: The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. Results: Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). Conclusion NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Purpose: Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. Materials and methods: We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. Results: The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. Conclusions The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare