Ferguson versus Stapled Hemorrhoidectomy

PURPOSE: The circular stapled hemorrhoidectomy is a newly introduced treatment modality for hemorrhoids. This study was aimed to prove the clinical efficacy of a stapled hemorrhoidectomy. METHODS: This prospective study analyzed 100 patients who underwent a hemorrhoidectomy from Jan 2002 to June 2004 at Ajou University Hospital. Among them, 50 patents underwent a stapled hemorrhoidectomy and the remaining patients underwent Ferguson's closed hemorrhoidectomy. The surgical severity and the postoperative complications were analyzed based on the medical records. RESULTS: Neither groups showed significant postoperative complications. In the stapled hemorrhoidectomy group, the hospital stay and the mean operation time were shorten during the postoperative period, and the analagesic requirement was lower (P<0.05). CONCLUSIONS: The circular stapled hemorrhoidectomy is safe, less painful, and those related easy to perform. Also, the complications related to this procedure are similar to those related to a conventional hemorrhoidectomy. Considering the advantages, the circular stapled hemorrhoidectomy is an acceptable modalities for hemorrhoids requiring surgical treatment.

Comparison of Two Rapid Antigen Detection Tests for Diagnosis of Group A Streptococcal Pharyngotonsillitis

PURPOSE: Recently, a number of rapid antigen detection tests have been available to diagnose group A streptococcal pharyngotonsillitis. The purpose of this study was to determine the sensitivity, specificity and consistency of the two rapid antigen detection tests. METHODS: Among the patients who visited our clinic from November 2001 to February 2002, 61 patients who had clinical findings of pharyngeal erythema or edema, pharyngeal exudates and soft palatine petechiae were enrolled in our study. A total of 61 patients were tested with rapid antigen detection tests and throat culture. BD LINK2TM Strep A(Becton, Dickinson and Company, U.S.A.) and QuickVue(R) In-LineTM(Quidel Corporation, U.S.A.) were selected for rapid antigen detection tests. RESULTS: Of the 61 patients tested, 22 patients were confirmed as group A streptococcal pharyngotonsillitis by throat culture. The BD LINK2TM Strep A had a sensitivity of 81.8% and a specificity 89.7%. The positive and negative predictive values were 81.8% and 89.7%, respectively. The QuickVue(R) In-LineTM had a sensitivity of 77.3% and a specificity of 100%. The positive and negative predictive values were 100% and 88.6%, respectively. The kappa values of BD LINK2TM Strep A and QuickVue(R) In-LineTM were 0.72 and 0.81, respectively. CONCLUSION: In addition to high sensitivity, specificity and consistency, both kits are easy to use and simple to interpret, and therefore have the potential to be used with backup throat culture for diagnosis of acute pharyngotonsillitis.

A Case of Citrullinemia Diagnosed at the Neonatal Period

Citrullinemia is a rare inborn error of metabolism of the urea cycle, and was first reported by McMurray, et al. in 1962. It is inherited as an autosomal recessive trait. The normal synthesis of argininosuccinic acid is blocked in this disease due to a deficiency of argininosuccinic acid synthetase(AS), which has been demonstrated in liver cells and fibroblasts. The clinical symptoms are vomiting, lethargy or irritability, convulsion and mental retardation. The diagnosis is made by the finding of an increased plasma citrulline level. Every effort should be made to reduce the blood ammonia level as rapidly as possible before irreversible brain damage occurs. This report describes a case of citrullinemia that was diagnosed through organic acid analysis and amino acid analysis, and reviews the related literatures.

A Clinical Evaluation of Chlamydia Trachomatis Infection in Women / 대한산부인과학회잡지

OBJECTIVE: Chlamydia trachomatis is one of the most common causative microorganisms in pelvic inflammatory disease. The symptom of Chlamydia infection is nearly absent or weak in many cases, but its complication is clinically very important because of tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic inflammatory disease. This study was performed to investigate the prevalence rate and clinical characteristics of Chlamydia trachomatis. METHODS: From May, 2001 to April, 2002, in Daerim St. Mary's Hospital, OB-Gyn department, the 68 inpatients of pelvic inflammatory diseases and 607 outpatients of routine gynecologic examination were studied on history taking, physical examination, laboratory test, and polymerase chain reaction for the detection of Chlamydia trachomatis. RESULTS: The prevalence rate of Chlamydia trachomatis was 20.6% (14/68) in pelvic inflammatory disease and 8.6% (51/593) in routine gynecologic examination. As regarding the age distribution of Chlamydia trachomatis positive group was the largest portion in the twenties, and symptom-free group was about 40%. Chlamydia infection was related to the history of artificial abortion, and showed no significant difference in parity. Most common site of infection was uterine cervix, and mixed infection rate with other bacteria was 43.1%. The treatments were given medically in 58 cases, surgically in 6 cases, and laparoscopy in 1 case were performed. CONCLUSION: Although the prevalence rate of Chlamydia infection is high in sexually active age group and Chlamydia infection has a serious bad effect on reproduction, the disease detection is difficult because symptom is weak or absent, but it reveals good cure rate. Therefore the screening and treatment of Chlamydia trachomatis are necessary to decrease the prevalence and prevention of complication.

A Case of Wernicke's Encephalopathy associated with Hyperemesis Gravidarum / 대한산부인과학회잡지

Hyperemesis gravidarum is characterized by severe nausea, vomiting followed by weight loss, dehydration, electrolyte imbalance and acid-base derangements. Its treatment was composed of adequate fluid therapy, electrolyte replacement and nutrient supply. In severe case, it also leads to a variety of neurological symptoms including confusion, gait disturbance and nystagmus, possibly due to thiamine deficiency and may result in so called Wernicke's disease. We have experienced a case of Wernicke's encephalopathy associated with severe hyperemesis gravidarum and this case is presented with a brief review of literature.

A Clinical and Histopathologic Study of Ovarian Hemorrhagic Lesions / 대한산부인과학회잡지

No abstract available.

The Effects of 5% Oxygen Condition and Superoxide Dismutase ( SOD ) on the in - vitro Development of Preimplantation Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: In the human body the embryo initially gmws in the fallopian tube which is maintained in an 3-8% O2 concentration environment, and various substances such as growth factors and antioxidants present in tbe tubal fluid assists in maintaining a healthy environment for embryo development. But in IVF programs embryo cultures are conducted in incubators with 21.9% O2 and 5% CO2 condition, and such high oxygen concentrations have been reported to increase the production of oxygen free radicals within the embryo and is detrimental to the growth and development of the embryo. The objective of this study, therefore, is to determine the culture conditions which will decrease oxygen free radical production and thereby minimize the injury to the embryo. METHODS: Six to eight week old ICR strain mice embryos were cultured in 5% or 21.9% O2 conditions and in culture media to which inaement concentrations of superoxide dismutase (SOD) had been and the H2O2 concentration within the embryo, embryo developmental rate, and degree of fragmentation of the embryos was investigated. RESULTS: The control gmup embryos which were cultured in 21.9% O2 condition without addition of SOD showed developmental arrest at the 2-cell stage or fragmentation, while those cultured in 21.9% O2 condition with addition of SOD showed development to the blastocyst stage with deaeased fragmentation. In particular, the blastulation and fragmentation rates were the lowest in the group to which 500 IU/ml of SOD was added, but in the 5% O2 enviranment group many embryos reached the blastocyst stage and with no difference in frapnentation with or without addition of SOD. The HO relative intensity (120.5+/-20.2) within the embryos cultured in 21.9% O2 environment without SOD was significantly higher than that (56.8+/-10.8) of group with SOD (p<0.05). As showing that in the 5% O2 environment group without SOD it was 43.8+/-7.8 and in the group with SOD it was 37.3+/-5.4, the H2O2 concentration within embryos cultured in 5% 02 condition was significantly lower those that of 21,9% 02 environment regardless of SOD addition (p<0.05). CONCLUSION: The optimal oxygen concentration in incubator for mice embryo cultures is that which is similar to the 5% 0 concentration in vivo. When 20% 02 incubators are routinely used, the addition of SOD to the culture media will decrease the H2O2 concentration within the embryos with subsequent improvement in development. The optimal concentration which should be used is thought to be 500 IU/ml. It is suggested that the use of the above method in human IVF-ET programs will lead to improved embryo quality and enhanced pregnancy rates.

Diagnostic Accuracy of Cytology, Colposcopically Directed Biopsy and Conization and Predictive Factors for Residual Tumor after Conization in Patients with Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. METHODS: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. RESULTS: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. CONCLUSION: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.

A Clinical Study of Placenta Previa / 대한산부인과학회잡지

OBJECTIVE: A Clinical Study of Placenta P#revia done by cesarean section and the study of preterm delivery that is major cause of premature motality even thought expected managment of placente previa. METHODS: This study was evaluated for the clinical analysis on the 641 patients with placenta previa among total deliveries of 56,120 cases at the St. Mary and Holy Family hospital of Catholic University from Jan. 1,1989 to Dec.31,1997. RESULTS: The following results were obtained: 1. The total incidence of placenta previa was 1.14%. 2. The incidence of placenta previa increases with age. 3. Placenta previa has occurred more often in multipara(60.2%) than primipara(39.8%), and placenta previa has occurred more often in women who had experienced abortion(71.8%) than women who hadnt(28.2%). 4. The types of placenta previa distributed 326 cases of totalis(50.9%), 110 cases of partialis(17.2%), 99 cases of marginal(15.4%) and 106 cases of low lying placenta(16.4%). 5. The fetal presentation distributed 557 cases of vertex(86.9%), 49 cases of breech(7.6%), 28 cases of transverse lie(4.4%). 6. The types of uterine incision included 543 cases of low sepnent transverse incision(84.7%), 46 cases of classical incision(7.2%), 9 cases of inverted T incision and 43 cases of cesarean hysterectomy(6.7%). 7. Premature delivery of placenta previa prior to completion of 37 weeks was 186 cases(29.0%) and low birth infant less than 2,500gm was 128 cases(20.0%).and perinatal mortality rate was 28.0 per 1,000. 8. During delivery, 278 cases of placenta previa(43.4%) were transfused with mean 3.6 pints. Incidence of vaginal bleeding was 49.3% of placenta previa,mean admission day until delivery was about 5 day. CONCLUSION: there is a strong association between advancing age and incidence of placenta previa, and then. the risk increases with parity & the number of abortion. Considering the mean volume of blood loss more than 3 pints of blood should be prepared befor delivery.

Postpartum 75g Oral Glucose Tolerance Test in Mothers of Macrosimia / 대한주산의학회잡지

Maternai diabetes is the most important known risk factor for development of fetal macrosomia. An attempt to study macrosomia and gestational diabetes was made using oral glucose tolerance test (OGTT) in early puerperium. Patients were divided into two groups: The macrosomia group was mothers who delivered largc fetuses over 4Kg. The control group was mothers who delivered normal weight fetuses (3.5-3.9Kg). The 75g OGTI' was done within 48 hours after delivery. The results were that 12% of the macrosomia group had abnormal glucose intolerance but only 2% of controi group showed an abnomal glucose level. Definite diabetes were not seen in either groups. In conclusion, if a glucose tolerance test has not been performed prenatally, the 75g oral glucose toleranre test has some usefulness within 48 hours postpartum in the macrosomia group which has the possibility of gestational diabetes.

Simultaneous Three Color Detection of Surface Antigen (My 7), Intracellular Antigen (c-myc), and DNA Content using Single Laser Flow Cytometry / 대한산부인과학회잡지

Flow cytometry, a useful tool for measuring DNA content and cell differentiation as expressed by cell surface markers, is utilized to measure multiple antigens, especially surface antigen, intracellular oncoprotein, and DNA content, simultaneously. For this simultaneous detection, several methods off ixation and permeabilization have been used with limited values. In this study, 20 ng/ml of lysolecithin in 1% paraformaldehyde solution was utilized for fixation and permeabilization of cultured promyelocytic leukemic cells(HL 60). The cells were first stained with phycoerythrin (PE)-conjugated monoclonal antibody to the cell surface My 7 antigen and then were fixed and permeabilized with 20 ng/ml of lysolecithin in 1% partormaldehyde solution. After incubation, the fixed and permeabilized cells were stained with monoclonal antibody to intracellular c-myc antigen, which were followed by fluorescein isothiocyanate (FITC)-conjugated secondary antibody. The c-myc stained cells were finally stained for DNA content with 7-amino-actinomycin D(7-AAD). This procedure permits excellent staining for intracellular oncoproteins and preservation of surface antigens with relatively low cofficients of variation (CV) for the G0G1 peak of the DNA histograms and suggests that the sequential staining procedure of surface antigen, intracellular antigen, and DNA content will be extended for the study of correlations with cellular differentiation, expression of oncoproteins, and cell cycle analysis in the cells which are obtained from human malignant diseases using a 488 nm single laser flow cytometry.

A Case of Primary Tubal Choriocarcinoma / 대한산부인과학회잡지

Primary trbal choriocarcinoma is extremely rare. We have experienced a case of primary tubal choriocarcinoma and report with a brief review of its related literatures.

Exression of p53, Proliferating Cell Nuclear Antigen(PCNA), c-myc, and Epidermal Growth Factor Receptor(EGFR) in Cervical Neoplasia / 대한산부인과학회잡지

No abstract available.

A Case of Retroperitoneal Neurilemmoma Presenting as an Adnexal Mass / 대한산부인과학회잡지

Retroperitoneal neurilemmoma is relatively rare and benign tumor. We report a case of a benign retroperitoneal pelvic neurilemmoma that presented with constipation and an adnexal mass and brief review of literatures.

A case of uterine tumor resembling ovarian sex-cord tumor / 대한산부인과학회잡지

No abstract available.

Review for 25 cases of stress urinary incontinence using modified stamey procedures / 대한산부인과학회잡지

No abstract available.

Clinical significance of CA 125 in epithelial ovarian carcinoma / 대한산부인과학회잡지

No abstract available.

The purpose of methtrexate saturation test in chemotherapy of gestational trophoblastic disease / 대한산부인과학회잡지

No abstract available.

Identification of Human Papillomavirus(HPV) in Patients with Cervical Cancer by DNA Hybridization / 대한부인종양콜포스코피학회잡지

Genomic DNAs were extracted from cervical lavages of 49 patients with cervical cancer. Dot and Southern blot hybridization were performed using the P-labeled HFV DNA probes to find high risk HPV(type 16 and 18) infection that is known as the mast prevalent pathogenic factor in cervical cancer. Furthermore, genornic DNAs purified frnm cervical cancer tissues were studied in 8 out of 49 patients allowing us to convince the results from cervical lavages. The results were as follaws: 1. Dot blot analysis were used to examine the sensitivity and specificity of hybridization condition and HPV-DNA probes. Fasitive signals were obtained even at the level of 10pg for HPV DNA, but no signals could he detected at the level of as much as 400pg for salmon sperm DNA. 2. Dot blot of DNAs from cervircal lavages showed positive signals in 32.7%(16/49) with HPV type 16 probe and 20.4% (10/49)and one mixed infection was found. 3. When the DNAs from cervircal lavages of 49 patients were classified according to the clinical stage of cervical cancer, the infection rates of HPV type 16 and 18 were 50% (2/4) in CIN, 80% (4/5) in stage I, 64. 2% (9/14) in stage I b, 45% (9I20) in stage II and 16. 7% (1/6) in stage Ill and K respectively. The occurrenr,e of HPV type 16 and 18 seemed to be the highest in the cervical cancer stage 1 (68.4%(13/19). 4. Experiments perfornecl with genomic DNAs from 8 cancer tissues showed similar results compared to those of cervical lavages, but the intensity of positive signals was stronger. 5. Genomic DNAs from 5 patients(3 cases from cervical lavages and 2 cases from cervical cancer tissues) which showed strong positive signals to the dot blot analysis were further examined by Southern blot hybridixation using HFV type 16 DNA probe. When DNAs were digested with Pst 1 restriction enzyme, the five characteristic frgmenta of BFV type 16(2.8, l.9, l.6, 1.0 and 0.5 kb long in length) were recognized in ell 5 cases, These results may suggest a direet relatianship between HPV type 16 & 18 infectioas considered as the most effective methods for HPV detectioe and typing. Mo1ecular biclogieal studies in the reserarch of HPV are expected to reveal and help us understand the pathogenesis of cervical cancer.