Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.
Aged, 80 and over ; Biliary Fistula/*complications ; Cholelithiasis/complications ; Common Bile Duct Diseases/*complications ; Diverticulum/*complications ; Duodenal Diseases/*complications ; Female ; Humans ; Intestinal Fistula/*complications ; Pancreatic Fistula/*complications

We tested the hypothesis that angiotensin-converting enzyme (ACE) and angiotensinogen gene polymorphism influence the incidence, development and outcome of preeclampsia. Subjects were recruited from 90 Korean patients with preeclampsia during pregnancy and 98 age-matched controls. After isolation of DNA, polymerase chain reactions (PCR) were carried out to detect polymorphism of the ACE and angiotensinogen. M235T and T174M genotypes of angiotensinogen were determined by digestion with restriction enzyme endonuclease Tth 111-I and NCo I, respectively. The frequency of DD genotype was significantly greater in preeclampsia (0.36) than in controls (0.14) (p<0.05). The frequency of D allele was 0.55 in preeclampsia and 0.40 in controls (p<0.05). There were no differences in the onset of preeclampsia and pregnancy outcomes according to the ACE genotypes. There was no difference in the frequency of a allele of angiotensinogen M235T between the groups (0.79:0.78 in preeclampsia : controls). The frequency of T allele of angiotensinogen T174M gene was slightly increased, but not significantly, in preeclampsia (0.11) than in controls (0.07). In a multivariate analysis, only ACE genotype was associated with the development of preeclampsia (beta=0.27, p=0.05). In conclusion, a molecular variant of ACE, but not angiotensinogen, gene is associated with preeclampsia in Korean women.
Adult ; Angiotensinogen/*genetics ; Female ; Gene Frequency ; Genotype ; Human ; Korea ; Peptidyl-Dipeptidase A/*genetics ; *Polymorphism (Genetics) ; Pre-Eclampsia/*genetics ; Pregnancy

OBJECTIVE: To determine the clinical value of human papillomavirus deoxyribonucleic acid(HPV DNA) testing by polymerase chain reaction(PCR), specifically to examine whether HPV testing could identify the women with Pap smears read as mostly atypical squamous cells of undetermined significance(ASCUS) or more. METHODS: HPV DNA testing by PCR for 3 high-risk cancer associated genotypes(HPV 16, 18, 33), repeat Pap smears and colposcopically directed punch biopsies were performed concurrently on 169 women referred for cervical cancer screening test with a previous Pap smear read as ASCUS or more. RESULTS: HPV DNA testing positivity was significantly associated with abnormal cytology and high-grade squamous intraepithelial lesion(HSIL) and squamous cell carcinoma(SCC) in histology(P=0.034). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) of Pap smear and HPV testing for identifying 38 cases of histologically confirmed HSIL and carcinoma by different triage protocols(HPV positive or HSIL or SCC) among 169 women were 65.8%(25/38), 85.5%(112/131), 56.8%(25/44) and 89.6%(112/125), respectively. Also sensitivity, specificity, PPV and NPV were varied by ages and more higher in older. CONCLUSION: HPV DNA testing by PCR appears to offer an effective means by which women whose cervical Pap smears have been read as ASCUS or more could be triaged for colposcopically directed biopsy. The sensitivity for HSIL could be maintained in high and specificity markedly improved by HPV genotypes 16, 18, 33.
Biopsy ; Chromosome Aberrations* ; Female ; Genotype ; Human Papillomavirus DNA Tests ; Humans ; Mass Screening ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage ; Uterine Cervical Neoplasms

p73, a first p53 relative, has been identified at chromosome 1p36, a region that is deleted in variety of human cancers. This protein shares strong homology with p53 protein, suggesting functional similarities with p53. Indeed, p73 can activate p53 downstream genes inducing apoptosis or growth arrest in tumor cells lacking p53. This phenomenon leads us to investigate the function of p73 in ovarian cancer because aberrant p53 was very frequently found in this cancer. We hypothesize that DNA damaging agents trigger p53 dependent apoptotic pathway through p73 instead of p53 in ovarian cancer having aberrant p53. We selected SKOV3 ovarian cancer cell line having no p53 gene and treated this cell line with cisplatin. After the treatment, we examined the transcriptional level of p73 and p21. Moreover, to identify whether the status of p53 influence to the function of p73, we performed same experiment after inserting adenovirus mediated p53(Avp53) into cell line. We detected significantly increased transcripts of p73 whcn treated with cisplatin. But treated with Avp53 or combined treatment with cisplatin, the transcriptional levels were not changed. These data suggest that overexpression of p73 may be important to trigger apoptotic pathway when the p53 gene is lost, but not so important in cells having normal p53.
Adenoviridae ; Apoptosis ; Cell Line* ; Cisplatin ; DNA ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Ovarian Neoplasms*

Extraperitoneal inguinal endometriosis often presents as an inguinal mass in women of reproductive age, Approximately 40 cases of inguinal endometriosis have been documented in the sutgical and gynecological literature. The overall incidence is in the range of 0.4% of patients with endometriosis. The right side is much more commonly involved than the left (almost 90% of the time in one series of 23 patients), and rarely is the condition bilateral. The most frequent complaint of patients with inguinal endometriosis is an inguinal mass, followed by pain and enlargement of the mass near menstruation. Authors have experienced two cases of endometriosis of the extraperitoneal portion of the round ligament of uterus and report with a brief literature review.
Endometriosis* ; Female ; Humans ; Incidence ; Menstruation ; Round Ligament of Uterus* ; Uterus

Primary sarcomas of the uteriae cerrix are exceedingly rare neoplasms. They comprise less than 1 percent of all cancers, with an incidence of 0.2 to 0.4 percent of those originating in the cervix. Indeed, only 19 cases of primary cervical leiomyosarcomas have been reported in the English literature. We have recently experienced one case of leiomyosarcoma arising from the cervix in a 40-year-old woman. Therefore, we the case with a brief review of the literature.
Adult ; Cervix Uteri* ; Female ; Humans ; Incidence ; Leiomyosarcoma* ; Sarcoma

OBJECTIVE: To evaluate the status of cone margins and severity of cervical neoplasia as predictors of residual lesions in the remaining cervices, and provide guideline for further treatment or close follow-up. METHOD: We performed a 3-year retrospective study and reviewed 95 patients who had undergone cervical conization followed by subsequent hysterectomy. RESULT: The prevalence rates of positive cone margins were 33, 50, 44, 71 and 88% respectively in patients with cervical intraepithelial neoplasia(CIN)II, CIN III, cervical cancer stage Ia1, Ia2 and Ib1. The prevalence rates of positive residual lesions in postcone hy-sterectomy specimens were 0, 31, 19, 29 and 59% respectively in patient with CIN II, CIN III, cervical cancer Ia1, Ia2 and Ib1. Residual lesions were significantly more frequently found in patients with positive cone margins(51%) than in those with negative margins(4.8%). Positive predictive values of margin status for the presence of residual lesions were 0, 56, 36, 40 and 67% respectively. Negative predictive values of margin status for the absence of residual lesions were 100, 94, 94, 100 and 100% respectively. CONCLUSIONS: (1) The prevalence of positive cone margin and residual lesion increased with more severe cervical neoplasia. (2) Positive cone margins had significantly higher risks of residual lesion than negative cone margins. (3) Positive cone margin does not invariably indicate the presence of residual lesion. (4) Negative cone margin does not ensure the absence of residual lesion. Subsequent hysterectomy may be reserved for the patient with CIN III or cervix cancer having positive cone margin or invasive lesion, or the patient who is not reliable for continuous follow-up.
Conization* ; Follow-Up Studies ; Humans ; Hysterectomy ; Prevalence ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVES: Our study was to determine the usefulness of CA 125 screening for asymptomatic female subjects. Though CA 125 has been used as a useful marker for the detection of ovarian cancer, its efficacy to detect early ovarian cancer in asymptomatic women has not been established. STUDY DESIGN: From April 1995 to December 1997, a total of 13,038 subjects who visited our Center for Health Promotion were screened. Serum CA 125 level was measured by a radioimmunoassay kit (Centocor, USA). In most cases transvaginal ultrasound was done at the same time. The specificity, sensitivity and positive predictive value were obtained on the basis of normal CA 125 range between 2.4~36.3 U/ml. RESULT: 1) Two cases of ovarian cancer were detected out of 13,038 subjects screened. One ovarian cancer patient showed 1,625 U/ml of CA 125 level, on the other hand, the other level patient showed 27 U/ml. 2) Therefore, the sensitivity, specificity, and positive predictive value were 50%, 97.3%, and 0.3%, respectively. Since 346 cases out of 13,038 screened subjects showed false positive results on the basis of the upper limit of normal CA 125 level set at 36.3 U/ml,the false positivity was 2.6%. 3) The CA 125 levels in false positive cases ranged from 36.3 U/ml to 352.8 U/ml with the mean value of 66.19+/-51.47 (S.D.). 4) The clinical features of the false positive cases included uterine myoma including adenomoysis (150), benign ovarian cyst (19), cervicitis (6), tuberculosis (3), pregnancy (2), and each one case of breast cancer, mammary cyst, endometritis, lung cancer, liver cirrhosis, pancreatic cancer, cervical cancer, renal cyst, uterine anomaly, and post TAH state. In the remainder of false positive 156 cases, no abnormal findings were observed. Among 258 pateints who underwent combined tests of CA 125 and transvaginal ultrasound, the sensitivity of ovarian cancer was 100%. 5) The false positive rate was lower in the older age group (>50) than in the younger group (<50). CONCLUSION: The prevalance of ovarian cancer in our study was 0.0153% (15.3 per 100,000 population) which is comparable to the rate of 15.8 per 100,000 population reported by the Korean Medical Insurance Corporation. Although the CA 125 test by itself shows a low positive predictive value, its clinical usefulness as a screening test can be enhanced dramatically by the combined use of transvaginal ultrasound examination, especially in postmenopausal women.
Breast Neoplasms ; Endometritis ; Female ; Hand ; Health Promotion ; Humans ; Insurance ; Leiomyoma ; Liver Cirrhosis ; Lung Neoplasms ; Mass Screening ; Ovarian Cysts ; Ovarian Neoplasms ; Pancreatic Neoplasms ; Pregnancy ; Radioimmunoassay ; Sensitivity and Specificity ; Tuberculosis ; Ultrasonography ; Uterine Cervical Neoplasms ; Uterine Cervicitis

Alveolar soft-part sarcoma of the female genital tract are extremely rare. Fewer than 30 cases have been described in the literature. We experienced a case of alveolar soft-part sarcoma of the female genital tract which was diagnosed by routine light microscopic study using ultrastructural and immunohistochemical stain. We report this case with a brief review of the literature.
Female* ; Humans ; Sarcoma, Alveolar Soft Part*

OBJECTIVES: Recently high dose chemotherapy with autologous peripheral blood stem cell transplantation (APBSCT) has been investigated with the hope of maximizing tumor response and increasing survival. The purpose of this study is to evaluate the effect, feasibility, and toxicity of high-dose cyclophosphamide, thiotepa, and carboplatin (CTCb) with APBSCT in patients with metastatic or high risk primary breast cancer. METHODS: Four cases of high-risk primary breast cancer (with more than 10 involved axillary nodes) and three cases of metastatic disease in complete or partial response were enrolled. Peripheral blood stem cells were mobilized by G-CSF plus chemotherapy, and median number of collected mononuclear cells was 5.44 X 108/kg(range, 1.95-7.08 X 108/kg). High-dose chemotherapy of cyclophosphamide (1,500mg/m2/day), thiotepa (125mg/m2/day) and carboplatin (200mg/m2/day) was administered for 4 days and peripheral blood stem cells were reinfused to the patients 72 hours after the completion of chemotherapy. RESULTS: The median days of recovery for neutrophil (over 500/mm3) and for platelet (over 50,000/mm3) were 10 (range, 8 to 33) and 30 (range, 10 to 40). One patient suffered from seizure attack and grade 3 hepatotoxicity during high dose chemotherapy, There were no treatment-related death. Four patients with high-risk primary breast cancer remained disease-free at 2, 8, 12 and 19 months post-transplant. In one patient with bone metastasis, complete response was induced following APBSCT. All three patients with metastatic disease remained progression-free at 8, 18 and 19 months post-transplant. CONCLUSION: High-dose chemotherapy and autologous peripheral blood stem cell transplantation was feasible and would be a potentially effective treatment modality in high risk and metastatic breast cancer.
Blood Platelets ; Breast Neoplasms* ; Breast* ; Carboplatin* ; Cyclophosphamide* ; Drug Therapy* ; Granulocyte Colony-Stimulating Factor ; Hope ; Humans ; Neoplasm Metastasis ; Neutrophils ; Peripheral Blood Stem Cell Transplantation* ; Seizures ; Stem Cells ; Thiotepa*