Ultrasonography of Suspected Ileocolic Intussusceptions Performed by Emergency Medicine Residents

PURPOSE: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography of suspected ileocolic intussusception performed by emergency medicine (EM) residents who participated in a 2-hour focused ultrasound training program for intussusception. METHODS: This was a 16-month retrospective, observational study. Pediatric patients with suspected ileocolic intussusception who underwent ultrasound performed by second or third year EM residents were included in the study. The gold standard was a diagnostic work-up performed by a radiologist or clinical follow-up, compared with the results of ultrasonography performed by EM residents. RESULTS: A total of 38 patients were enrolled. The sensitivity of ultrasound performed by emergency medicine residents for prediction of ileocolic intussusception was 92.86%(66.13% to 99.82%), the specificity was 91.67%(73.00% to 98.97%), the positive likelihood ratio was 11.14(2.93 to 42.34), and the negative likelihood ratio was 0.08(0.01 to 0.52). CONCLUSION: Emergency residents can identify ileocolic intussusceptions with only minimal training, which could substitute for ultrasonography performed by radiologists when they are not immediately available.

Clinical analysis of intra-operative frozen section proven borderline tumors of the ovary / 부인종양

OBJECTIVE: We have assessed the accuracy of frozen section diagnosis and the outcomes of misdiagnosis in borderline tumors of the ovary (BTO) according to frozen section. METHODS: All pathology reports with BTO in both frozen and permanent section analyses between 1994 and 2008 at Seoul St. Mary's Hospital were reviewed. Frozen section diagnosis and permanent section histology reports were compared. Logistic regression models were conducted to evaluate the correlation of patient and tumor characteristics with diagnostic accuracy. The clinical outcomes of misdiagnosis were evaluated. RESULTS: Agreement between frozen section diagnosis and permanent histology was observed in 63 of 101 patients (62.4%). Among the 76 patients with frozen section proven BTO, under-diagnosis and over-diagnosis occurred in 8 of 76 (10.5%) and 5 of 76 patients (6.6%), respectively. Mean diameter of under-diagnosed tumor was larger than matched BTO (21.0+/-11.4 vs. 13.7+/-7.1; p=0.021). Tumor size 20 cm was determined as the optimal cut-off for under-diagnosis (50% sensitivity, 87.3% specificity). Among 8 under-diagnosed patients, no patient relapsed. Among 5 over-diagnosed patients, 2 patients < 35 years of age had fertility-preserving surgery. CONCLUSION: Although frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian tumors, over-diagnosis and under-diagnosis are relatively frequent in frozen proven BTO. Surgical decision-making for BTO based on frozen section diagnosis should be done carefully, especially in large tumors.

Adjuvant therapy in high-risk early endometrial carcinoma: a retrospective analysis of 46 cases / 부인종양

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.

Adjuvant therapy in high-risk early endometrial carcinoma: a retrospective analysis of 46 cases / 부인종양

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.

Interaction between Causative Factors of Cervical Cancer and BARD-1 (BRCA-associated ring domain-1) Polymorphism / 대한산부인과학회지

OBJECTIVE: The aim of this study was to identify interaction between causative factors of cervical cancer and BARD-1 (BRCA1 associated ring domain-1) polymorphism on cervical carcinogenesis in Korean women. METHODS: We evaluated 1,347 patients composed of women who had cervical cancer (n=337) and cervical intraepithelial neoplasia (n=308) and normal control healthy women (n=702) from October 2000 until November 2001. The single nucleotide polymorphisms (SNPs) of BARD-1 were evaluated from extracted DNA of peripheral blood with automatic DNA sequencer. The difference of each SNP between normal controls and patients was evaluated in the adjusted environmental background. RESULTS: In environmental aspect, the cervical cancer increased in the women who had the lower level of education, smoking history, the younger age of the first sexual intercourse, and the more child-bearing . The women who had BARD V507M (Arg/Arg) showed 1.6 fold increased risk in cervical cancer than the women who had BARD V507M (G/G), (G/A)(p=0.0433). And the risk increased with BARD R378S (C/C) among who have environmental risk factors compared with BARD R378S (G/G), (G/C) allele positive who have no environmental risk factors. CONCLUSION: We found that the level of education, the age at first intercourse, and the number of children were the independent risk factors in cervical carcinogenesis. The specific combination of BARD-1 and gene-environmental interactions were significantly noted in the cervical carcinogenesis in Korean women.

A Case of Parovarian Serous Cystadenocarcinoma of Borderline Malignancy / 대한산부인과학회잡지

Although parovarian cysts constitute 10-20% of all adnexal masses, malignant parovarian tumors are extremely rare. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, and prognosis of these tumors. Currently, it is suggested that these paovarian tumors should be treated similarly to their ovarian counterparts. We experienced one case of parovarian serous cystadenocarcinoma of borderline malignancy, and report this with a brief review of the literatures.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

Successful Delivery In Women With Advanced Liver Cirrhosis: Report Of 3 Cases / 대한산부인과학회잡지

There is high prevalence of HBV infection in Asian countries including South Korea. In fact, 8% of Koreans are HBV carriers, and 20-25% of them progress to liver cirrhosis. Liver cirrhosis, known to be the last stage of chronic liver diseases, is the most prominent cause of death in Korean males in their forties. However, women participation to social activities increased and also increased psychological stress that changed life style now days, and due to increased alcohol consumption liver disease has become a serious problem in korean women population. But as liver cirrhosis usually occurs after the menopause, and decreased fertility in cirrhotic patients, pregnancy in women with liver cirrhosis is rare. However, improved general care increased pregnancy rates and reports of pregnancy in women with liver disease worldwide. Studies on the effect of liver cirrhosis on pregnancy and the effect of pregnancy on the clinical progression of liver cirrhosis have not been well established, and the continuation of pregnancy in a patient with liver cirrhosis has been controversial. Recently, it has become favorable for the argument that pregnancy can be kept as long as liver function is maintained at certain level and portal hypertension is mild. The most common and fatal maternal complication is gastrointestinal hemorrhage. It increases maternal mortality and intrauterine developmental defect resulting in neonatal morbidity. Although South Korea is an area of high prevalence of HBV infection, there are few reports of pregnancies in women with liver cirrhosis. Recently, we have experienced the 3 cases of pregnancies in women with progressive liver cirrhosis who became pregnant. Although thrombocytopenia and increased coagulopathy complicated the pregnancy course, all women delivered healthy babies and were discharged in good condition.

A case of rotor syndrome / 대한내과학회지

Rotor syndrome is a rare benign familial disorder characterized by chronic, fluctuating, nonhemolytic and predominantly conjugated hyperbilirubinemia with normal liver tissue. In contrast to Dubin-Johnson syndrome, there is no liver hyperpigmentation in Rotor syndrome, and BSP clearance does not show a secondary retention peak. The serum bilirubin in patients with Gilbert's syndrome is almost all unconjugated in contrast to Rotor syndrome. A 29-year-old male was admitted due to persistent jaundice. Physical examination revealed icteric sclera without hepatosplenomegaly. Laboratory findings showed increased serum bilirubin with indirect bilirubin predominance. Urinary excretion of total coproporphyrin was markedly elevated, and coproporphyrin I was 66% of total urinary coproporphyrin. Oral cholecystography showed well visualized the gallbladder, but 99mTc-DISIDA scan showed markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tract. Histology of the liver showed no abnormal finding. We report the case with the review of literature.

A Case of Systemic Lupus Erythematosus with Mediastinal Lymphadenopathy / 대한류마티스학회지

Approximately half of the patients with systemic lupus erythematosus(SLE) develop localized or diffuse lymphadenopathy during the evolution of the disease. But hilar and mediastinal lymph node enlargement due to SLE is rare. The histologic findings of lupus lymphadenitis range from nonspecific lymphadenitis with variable degrees of cellular necrosis to the less common but more specific appearance of extensive necrosis. Advanced lesions are characterized by hematoxylin bodies and condensation of DNA on the vessel walls. Hematoxylin bodies are amorphous homogeneous violet or lilac colored structures composed of partially depolymerized DNA, mixed with protein, carbohydrates and globulins which may be seen deposited on vessel walls and within the paracortex of lymph node. They are virtually diagnostic of SLE and would exclude malignant lymphoma. SLE with mediastinal lymphadenopathy is rare so we report this case with a review of literatures, which was diagnosed by hematoxylin bodies on pathologin findings of cervical lymph node.