The purpose of this study was to identify the relationship between the clinical response to neoadjuvant chemotherapy and PCNA and VEGF protein expression, apoptosis and its related gene expression such as Bcl-2 and Bax in cervical cancer. We retrospectively reviewed 30 patients with locally advanced or bulky cervical cancer treated with three courses of neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy at Seoul National University Hospital from June 1995 to June 1998. The specimen were obtained before chemotherapy by colposcopy directed biopsy. The protein expressions of Bcl-2, Bax, VEGF and PCNA were examined by immunohisto- chemical staining and the apoptosis was examined by TUNEL staining. These results were compared with chemotherapeutical response which was evaluated by colposcopy or CT/MRI. There were 2 CR(complete response), 19 PR(partial response) and 9 NC(no change) and there was no progressive disease. There was no significant difference between responder and nonresponder according to the age, tumor size and FIGO stage. The 3 year survival rates of responder and nonresponder were 90.0% and 66.7% respectively and there was significant difference between two groups(p=0,015). The expression of Bcl-2 and Bax was positive in 23.3%(7/30) and 46.7%(14/30). The expression of VEGF was positive in 83.3%(25/30). PCNA PI(positive index), defined as PCNA positive cells in percentage was more than 25.0% in 20 cases. Apoptotic index, defined as the number of the cells undergoing apoptosis per 1,000 tumor cells, ranged from 3 to 53(mean 22.3). Although there was no significant relationship between the clinical response to neoadjuvant chemotherapy and the expre- ssion of Bcl-2, Bax, VEGF and PCNA PI, apoptotic index was significantly higher in responder than nonresponder when the cutoff value of positive was defined as apoptotic index more than 5(p=0.032). In conclusion, the evaluation of the pattern of apoptosis before neoadjuvant chemothera- py is potentially useful for the prediction ofz tumor response to neoadjuvant chemotherapy for cervical cancer.
Apoptosis* ; Biopsy ; Colposcopy ; Drug Therapy* ; Gene Expression ; Humans ; Hysterectomy ; In Situ Nick-End Labeling ; Proliferating Cell Nuclear Antigen* ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms* ; Vascular Endothelial Growth Factor A*

No abstract available.
Polymerase Chain Reaction*

As the traffic accidents and occupational accidents increase, the pure blow out fracture has been increased. If we could know the prognostic information of the pure blowout fracture according to the fracture sites, it would be of benefit in consulting the patients preoperatively and in planning the treatment. In this study we defined the posterior wall fracture as that extending 2 cm from orbital rim and the anterior wall fracture as that presenting within 2 cm from orbital rim. These fractures were individually classified into inferior wall fractures, medial wall fractures, and combined inferior and medial wall fractures, based on the operative finding and the preoperative CT scanning. We experienced 76 cases of pure blowout fracture patients underwent surgical correction and followed up the subsidence of diplopia and extraocular muscle limitation with ophthalmic Hess test. The results obtained are as following: 1. Posterior wall fractures were improved more slowly than anterior wall fractures. 2. Combined inferior and medial wall fractures were improved more slowly than isolate inferior wall or medial wall fractures. These results may be related to the difference of the traumatic forces and the anatomical structure of the fracture sites. These results inform the importance of accurate anatomical reconstruction of fracture sites and can be used as a prognostic information of the pure blow out fractures.
Accidents, Occupational ; Accidents, Traffic ; Diplopia ; Humans ; Orbit ; Orbital Fractures* ; Tomography, X-Ray Computed

PURPOSE: Generally, the constipation is a medical disease, but recently, there are many reports showing the good results after correction of rectocele in constipated patients. The authors try to show the effect of surgery in rectocele cases and also analyse the relationship between the anatomical distortion and clinical symptoms by using anorectal physiologic study before and after operation. METHODS: 31 cases of rectocele are surgically corrected from June 1998 to August 2001. 31 cases of them could be followed up and with them, pre- and post-operative anal ultrasonography, anorectal manommetry and defecography were tried. Personal interview was also done to each patient. RESULTS: After trasanal rectocele repair, the rectocele size decreased and clinical symptoms improved remarkably. In defecography, anorectal angle (pre-op; 105.9+/-6.0 degrees vs. post-op; 109.5+/-3.7 degees) and perineal descent (1.6+/-0.7 cm vs. 2.4+/-1.2 cm) increase in pushing state after operation. In anorectal manometry, mean resting anal pressure (29.2+/- 3.4 mmHg vs. 17.9+/-4.6 mmHg) and maximal squeeze pressure (84.5+/-20.8 mmHg vs. 47.6+/-12.1 mmHg) decreased and rectal sensation improved after operation. CONCLUSIONS: Current results suggest that the surgical correction aims not only the decrement of the rectocele size but changing the vector power on pushing more physiologically and also improving the rectal sensibility.
Constipation ; Defecography ; Humans ; Manometry ; Prospective Studies* ; Rectocele* ; Sensation ; Ultrasonography

Prior to 1988, endometrial cancer was clinically staged but there was the considerable discrepancy between clinical and aetual stage. FIGO surgical staging classification of endometrial cancer(I988) provides the advanatage of recognizing the true disease distribution and extension, and more rational treatraent can be accomplished. This retrospective study was based on a clinical review of 73 patients with endometrial carcinoma from l982 through 1991 who underwent primary surgical evaluation. A11 cases were restaged ueing the newly adopted FIGO surgical staging. The distribution of FIGO clinical staging was as follows:85 patients(89.1%) were with stage I, 5(6.9%) with stage II, 2(2.7%) with stage III and 1(l.3%) with stage IV. Surgical restaging according new FlG0 classification reveald 56(76.7%) patients with stage I, 1(1.4%) with stage II, 14(19.2%) with stage III and 2(2.7%) with stage IV. Surgery upstaged 12.3% of clinical stage I patients, In clinical stage II patients, 80.0% was doenstaged. There wes no stage changing in cliaical stage III and IV patients. The acturial survival rates for surgical stages I a, I b, I c, and III were 80.0%, 77.2%, 68.4A%, and 35.0% respectively. By using FIGO surgical staging, the initial extent of endometrial cancer can be more accurately evaluated and we may predict prognosis and survival relatively well.
Classification ; Endometrial Neoplasms* ; Female ; Humans ; Prognosis ; Retrospective Studies ; Survival Rate

PURPOSE: The present study was designed to evaluate the efficacy and the outcome when using the Starion(TM) and the Harmonic Scalpel(TM) vessel sealing systems for a sutureless hemorrhoidectomy. METHODS: This study is a randomized, controlled trial. Patients with Grade 3 and 4 hemorrhoids were categorized into two groups: the Starion(TM) hemorrhoidectomy (30 patients) group and the Harmonic Scalpel(TM) hemorrhoidectomy (30 patients) group. The measures of the primary outcomes were the operating time, the postoperative pain score, and the patient satisfaction score. Secondary outcome criteria included early and delayed complications: postoperative bleeding, anal stenosis, urinary difficulty, and skin tag. RESULTS: The satisfaction scores 4 wk postoperatively were not significantly different between the two groups (P=0.186). However, the operating time was reduced (P=0.019), the pain score was lower (P=0.009), and the satisfaction score 1 wk postoperatively (P=0.001) was lower in the Starion(TM) hemorrhoidectomy group. In addition, there were no differences in early and delayed postoperative complications between the two groups (all P>0.05). CONCLUSION: Both methods were found to be surprisingly equivalent in all major aspects analyzed. A Starion(TM) hemorrhoidectomy with submucosal dissection can provide a safe, fast, bloodless, reduced-pain, and low-priced surgical alternative to hemorrhoidal surgery. More studies are needed to determine whether similar favorable results can be attained in patients with more severe, strangulated hemorrhoids.
Constriction, Pathologic ; Glycosaminoglycans ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Skin

We have experienced two cases of extramammary Paget's disease. The first case was a 68-year-old male who showed erythematous, crusted, oozing, eczematoid patches on the scroturn, penile root and pubic area, and verrucous plaque on the left pubic area of 5 years' duration. The second case was a 60-year-old male who showed erythematous, oozing, hyperkeratotic plaque and nodular mass on the scrotum of 4 years' duration. In electron microscopic findings of the first case, the Paget's cells was suggested to be formed by pleuripotential germinative cells; well developed microvilli, numerous electron lucent secretory granules, a few electron dense granules, apocrine type secretion and well developed desmosome.
Aged ; Desmosomes ; Humans ; Male ; Microvilli ; Middle Aged ; Paget Disease, Extramammary ; Scrotum ; Secretory Vesicles

No abstract available.
Keratinocytes* ; Transplants*

PURPOSE: Rectoceles are often associated with anorectal symptoms. Various surgical techniques have been described to repair rectoceles, but the surgical results vary. The aim of this study was to compare transanal repair (TAR) and transanal repair with posterior colporrhaphy (TAR+PC). METHODS: The records of 58 patients operated on during a 56-month period were reviewed. Of those 26 patients had a TAR, and 32 patients had a TAR+PC. Interviews and anorectal physiologic studies were performed preoperatively and postoperatively. RESULTS: The recurrence rate after a TAR+PC was lower than the recurrence rate after a TAR (TAR 19.2% vs. TAR+PC 3.1%). The rectal sensation (sensory threshold: TAR 64.8+/-18.9 ml vs. TAR+PC 56.1+/-23.67 ml; earliest defecation urge: TAR 116.4+/-29.5 ml vs. TAR+PC 104.8+/-31.2 ml) was more improved after a TAR+PC. CONCLUSIONS: A TAR+PC for treatment of a rectocele is safe and effectively corrects obstructed defecation. The improvement probably relates, at least in part, to rectal sensational factors other than the dimensions of the rectocele.
Defecation ; Humans ; Rectocele* ; Recurrence ; Sensation

PURPOSE: Idiopathic pruritus ani is a common and embarrassing proctological condition which can be very difficult to treat. In this study, we documented our results with methylene blue intra-dermal injection in patients with intractable idiopathic pruritus ani. METHODS: 5-ml 1% methylene blue, 100-mg hydrocortisone, and 15-ml 1% lidocaine were injected into the perianal skin of 21 patients with idiopathic pruritus ani which had proved refractory to standard care. Clinical follow-up was undertaken. RESULTS: After one injection of the above solution, 15 (71.4%) of the patients were rendered symptom free. Repeat injection in the initial non- responders ultimately rendered another four. 19 (total: 90.5 %) of the patrents symptom free. Morbidity was 0%. CONCLUSION: This study has shown that intra-dermal methylene blue injection is a safe, simple, and efficient method of treating intractable, idiopathic pruritus ani.
Follow-Up Studies ; Humans ; Hydrocortisone* ; Lidocaine* ; Methylene Blue* ; Pruritus Ani* ; Pruritus* ; Skin