OBJECTIVE: To understand the difference of defecation physiology between postpartum and postoperative women. METHODS: Between July 1998 to April 1999, we performed defecogram and pudendal nerve motor latency to 31 women, who were 8 postoperative women, 9 post cesarean-section state women, and 14 normal vaginal delivery-state women. RESULTS: According to the defecogram results, only squeezing angles of the anorectal angle were significantly increased(96.0 vs 72.3, 74.9 degree) in normal vaginal delivery-state women compared to post cesarean-section state and postoperative women, but rest and evacuation angles were not. And to pudendal nerve latency, there were no statistically significant difference. CONCLUSION: We concluded that the pudendal plexus was damaged during labor, therefore its ability to control puborectalis muscle was damaged. So, the anorectal angles of squeezing of postpartum women were significantly increased, compared to those of post cesarean section women or postoperative women.
Cesarean Section ; Defecation* ; Female ; Humans ; Physiology* ; Postpartum Period* ; Pregnancy ; Pudendal Nerve*

BACKGROUND: Fibroadenoma is a common benign breast tumor that has a rare malignancy rate. However, various studies reported that it is associated with a certain increase in breast cancers. CASES: We report three cases of malignancy arising from a breast fibroadenoma. They were 32, 36 and 52 years old and presented with a lump of recent onset. Any one of mammography, ultrasonography and cytologic examination could diagnose malignancy exactly. But cytological examination demonstrated atypical cells with fibroadenoma in two cases. Wide excision was performed in two cases and localization & excisional biopsy was performed in an occult case. Pathologic report of the cases revealed them as DCIS in a fibroadenoma. CONCLUSION: Possibility of malignancy cannot be excluded in fibroadenomas especially in case with calcifications within the mass in the radiological study or with atypical cells presented in the cytology. Cytology and ultrasonogram should be used to evaluate fibroadenomas. If there are any suspicion of malignancy, excisional biopsy should be performed to confirm the benign state.
Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Fibroadenoma* ; Humans ; Mammography ; Middle Aged ; Ultrasonography

The timing of puberty onset varies greatly among individuals, and much of this variation is modulated by genetic factors. This study aimed to identify the kisspeptin receptor (KISS1R) gene variations and to investigate the associations between these variations and central precocious puberty (CPP). Korean girls with CPP (n = 194) and their healthy controls (n = 99) were included in this study. The entire coding region and the exon-intron boundaries (exon 1 through 5) of the KISS1R gene were directly sequenced. Seven polymorphisms were identified in the KISS1R gene. A missense change c.1091T>A, and an intron variant c.738+64G>T showed significantly higher allele frequencies in CPP patients than in controls (c.1091T>A: 30.7% vs. 22.2%, P = 0.031; c.738+64G>T: 45.6% vs. 35.9%, P = 0.023). The missense variant (c.1091T>A) was a nonsynonymous polymorphism that induces amino acid substitution of p.Leu364His. The haplotype CAGTGTC was detected more frequently in the CPP group (P = 0.042). The sequence variants of the KISS1R gene can be inducible factors in the development of CPP. The association between sequence variants and CPP should be validated by further evidence obtained from larger samples of children with CPP.
Adolescent ; Amino Acid Substitution ; Child ; Clinical Coding ; Female* ; Gene Frequency ; Genetic Variation* ; Haplotypes ; Humans ; Introns ; Puberty ; Puberty, Precocious*

BACKGROUND: A fibroadenoma is a common benign breast tumor with little potential for malignancy. There are, however, increasing numbers of reports that it is associated with a certain increase in breast cancer. METHODS: We reviewed the medical records of 4 patient's who were diagnosed as intraductal carcinoma within a fibroadenoma. RESULTS: The patient's age were relatively young (32, 36, 52, and 36 years), and the tumor presented as a lump of recent onset in 3 patients and as an abnormal mammography in one patient. None of the patients could be diagnosed as having malignancy by using mammography, ultrasonography, or cytologic examination. However, a radiologic study showed microcalcifications in the masses in two patients, and cytological examination demonstrated atypical cells in three patients. Breast-conservation surgery was performed in two patients; a wide excision was used in one and a localization & excision in the other. Pathologic features were ductal carcinomas in situ within fibroadenomas in all. Estrogen and progesteron receptors were all positive. CONCLUSION: Possibility of malignancy should be excluded in patients with a fibroadenoma, especially when microcalcifications are observed within the mass or atypical cells are suspected based on cytologic examination. Fine needle aspiration cytology, ultrasonography and even excisional biopsy should be performed to evaluate the possibility of malignancy in these patients.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Fibroadenoma* ; Humans ; Mammography ; Medical Records ; Ultrasonography

PURPOSE: Insular carcinoma is a rare subtype of thyroid cancer which is first described by Carcangiu in 1984. It is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinoma. But its origin, clinical features and prognosis are not yet clearly understood. We wanted to evaluate the clinical features, histologic characteristics and the prognosis of the insular thyroid carcinoma. MATERIALS AND METHODS: We studied 4 cases of insular thyroid carcinoma treated in Samsung Medical Center from March 1996 to April 1998. Age, sex, clinical features, treatment, pathology and follow up findings were reviewed, retrospectively. RESULTS: All patients were female and mean age was 44 years. Three of four patients complained anterior neck mass and one patient complained low back pain and paresthesia of right thigh. Two patients had metastatic bone lesions at the time of diagnosis. Preoperative fine needle aspiration cytology could diagnose follicular neoplasm in 2 cases and papillary carcinoma in 1. We performed total or completion thyroidectomy and radioactive iodine therapy in 3 cases and radioactive iodine therapy alone in one. Extra- thyroidal invasion, vascular invasion and multicentricity was noted in two cases. All four patients showed recurrence or distant metastasis in follow up period of 10~31 months and 2 of them died of distant metastasis. CONCLUSION: Insular carcinoma is a special type of thyroid carcinoma with aggressive clinical course. Recurrence and extrathyroidal involvements are common and the prognosis is poorer than other well differentiated thyroid carcinoma.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Iodine ; Low Back Pain ; Neck ; Neoplasm Metastasis ; Paresthesia ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Thigh ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

A case of huge cystosarcoma phyllodes is presented. A 45-year-old female visited our clinic because she had had a mass in the right breast for two and a half years. She had performed breast mass excisions at the same site on 2 different occasions, 5 and 3 years ago. The tumors consisted of benign phyllodes, and there had been necrosis with a foul odor in half of the mass surface. A total mastectomy was performed due to the large size (30x22 cm), the recurrent nature and a fear of malignancy. The tumor was somewhat incompletely well-encapsulated and was adherent to the pectoralis major. Pathologic findings revealed that the tumor was made up of malignant cystosarcoma phyllodes.
Breast ; Female ; Humans ; Mastectomy, Simple ; Middle Aged ; Necrosis ; Odors ; Phyllodes Tumor*

A right-sided aortic arch (RAA) is a rare congenital anomaly, and Stanford type B dissection aneurysms involving this anomaly is also uncommon. Surgical approaches to dealing with an RAA are complicated by the unusual anatomical features of the condition. Here we report the case of a 47-year-old male who had a type B dissecting aneurysm involving an RAA with Kommerell's diverticulum. Graft replacement was successfully performed with an uneventful postoperative course.
Aneurysm, Dissecting/radiography/*surgery ; Aorta, Thoracic/*abnormalities/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Diverticulum/radiography/*surgery ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: To identify the differences in the movement of the hyoid bone and the vocal cord with and without electrical stimulation in normal subjects. METHODS: Two-dimensional motion analysis using a videofluoroscopic swallowing study with and without electrical stimulation was performed. Surface electrical stimulation was applied during swallowing using electrodes placed at three different locations on each subject. All subjects were analyzed three times using the following electrode placements: with one pair of electrodes on the suprahyoid muscles and a second pair on the infrahyoid muscles (SI); with placement of the electrode pairs on only the infrahyoid muscles (IO); and with the electrode pairs placed vertically on the suprahyoid and infrahyoid muscles (SIV). RESULTS: The main outcomes of this study demonstrated an initial downward displacement as well as different movements of the hyoid bone with the three electrode placements used for electrical stimulation. The initial positions of the hyoid bone with the SI and IO placements resulted in an inferior and anterior displaced position. During swallowing, the hyoid bone moved in a more superior and less anterior direction, resulting in almost the same peak position compared with no electrical stimulation. CONCLUSION: These results demonstrate that electrical stimulation caused an initial depression of the hyoid bone, which had nearly the same peak position during swallowing. Electrical stimulation during swallowing was not dependent on the position of the electrode on the neck, such as on the infrahyoid or on both the suprahyoid and infrahyoid muscles.
Deglutition ; Deglutition Disorders ; Depression ; Electric Stimulation* ; Electrodes ; Hyoid Bone ; Jupiter ; Muscles ; Neck ; Neck Muscles ; Vocal Cords

OBJECTIVE: To evaluate the accuracy of predicted birth weight percentile and large for gestational age(LGA) fetuses by the gestation-adjusted projection method using estimated fetal weight. METHODS: From 462 low-risk pregnancies with singleton fetus, fetal biometry including fetal biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC), and femur length(FL) was made from 30 weeks of gestation until term. Estimated fetal weight(EFW) by combinations of fetal biometry were made by Campbell, Hadlock1, Hadlock2, and Shepard formulas respectively. The diagnostic accuracy according to 4 formulas was assessed by correlation between EFW percentile and birth weight percentile, prediction of LGA fetuses, and prediction error(percentile difference between birth weight and EFW). RESULTS: The mean gestational age on ultrasound and on birth, and birth weight were 33.21 +/- 2.08(30-40) weeks, 38.43 +/- 1.72(30-42) weeks, and 3.14 +/- 0.47(0.99-4.38) Kg, respectively. The diagnostic accuracies of gestation-projection method using EFW were similar result to predict birth weight percentile and LGA fetuses according to 4 formulas. Correlation between EFW percentile and birth weight percentile(correlation coefficient, r) were Campbell: 0.644(p <0.001), Hadlock 1: 0.682(p <0.001), Hadlock 2: 0.681(p <0.001), Shepard: 0.638(p <0.001), respectively. Youden's index(sensitivity + specificity - 1) in prediction of LGA fetuses were Campbell: 0.532, Hadlock1: 0.525, Hadlock2: 0.520, Shepard: 0.549, respectively. Prediction error were Campbell: 18.14+/-16.56, Hadlock1: 16.19+/-14.35, Hadlock2: 16.10+/-14.29, Shepard: 19.68+/-17.00, respectively. The prediction error was increased according to increasing of lapse time(p <0.001), gestational weeks on ultrasound, and estimated fetal weight percentile, and decreasing birth weight percentile(p <0.001)(R square=0.411, (p <0.001). But, amniotic fluid index did not affect to prediction error(p=0.199). CONCLUSION: Our study presented relatively accurate prediction for birth weight percentile and LGA fetuses from remote sonographic examination. If LGA fetuses was suspected by antenatal ultrasound, adequate therapy and periodic observation are recommended for good perinatal outcome.
Amniotic Fluid ; Biometry ; Birth Weight* ; Female ; Femur ; Fetal Weight* ; Fetus* ; Gestational Age* ; Head ; Parturition* ; Pregnancy ; Sensitivity and Specificity ; Ultrasonography

Rectal prolapse is a protrusion of the rectum beyond the anal canal. Since rectal prolapse is a surgical disease, it is mostly diagnosed and treated at the surgical department. However, when surgical complications occur or they are suspected after an operation for colorectal disease, colonoscopy may now have a role in diagnosing the actual status of the problem. We present here the case of penetration of mesh at the distal rectum that was incidentally diagnosed by colonoscopy and the patient had previously undergone presacral rectopexy for rectal prolapse. Only one such case has been reported abroad and there has been no such case report in Korea. We report here on a case for which colonoscopy had a crucial role in diagnosing an occult complication after a colorectal operation that used a prosthesis.
Anal Canal ; Colonoscopy ; Humans ; Korea ; Prostheses and Implants ; Rectal Prolapse ; Rectum