Liver-to-Spleen Volume Ratio Automatically Measured on CT Predicts Decompensation in Patients with B Viral Compensated Cirrhosis

Objective@#Although the liver-to-spleen volume ratio (LSVR) based on CT reflects portal hypertension, its prognostic role in cirrhotic patients has not been proven. We evaluated the utility of LSVR, automatically measured from CT images using a deep learning algorithm, as a predictor of hepatic decompensation and transplantation-free survival in patients with hepatitis B viral (HBV)-compensated cirrhosis. @*Materials and Methods@#A deep learning algorithm was used to measure the LSVR in a cohort of 1027 consecutive patients (mean age, 50.5 years; 675 male and 352 female) with HBV-compensated cirrhosis who underwent liver CT (2007–2010).Associations of LSVR with hepatic decompensation and transplantation-free survival were evaluated using multivariable Cox proportional hazards and competing risk analyses, accounting for either the Child-Pugh score (CPS) or Model for End Stage Liver Disease (MELD) score and other variables. The risk of the liver-related events was estimated using Kaplan-Meier analysis and the Aalen-Johansen estimator. @*Results@#After adjustment for either CPS or MELD and other variables, LSVR was identified as a significant independent predictor of hepatic decompensation (hazard ratio for LSVR increase by 1, 0.71 and 0.68 for CPS and MELD models, respectively; p < 0.001) and transplantation-free survival (hazard ratio for LSVR increase by 1, 0.8 and 0.77, respectively; p < 0.001). Patients with an LSVR of < 2.9 (n = 381) had significantly higher 3-year risks of hepatic decompensation (16.7% vs. 2.5%, p < 0.001) and liver-related death or transplantation (10.0% vs. 1.1%, p < 0.001) than those with an LSVR ≥ 2.9 (n = 646). When patients were stratified according to CPS (Child-Pugh A vs. B–C) and MELD (< 10 vs. ≥ 10), an LSVR of < 2.9 was still associated with a higher risk of liver-related events than an LSVR of ≥ 2.9 for all Child-Pugh (p ≤ 0.045) and MELD (p ≤ 0.009) stratifications. @*Conclusion@#The LSVR measured on CT can predict hepatic decompensation and transplantation-free survival in patients with HBV-compensated cirrhosis.

How to Combine Diffusion-Weighted and T2-Weighted Imaging for MRI Assessment of Pathologic Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer?

Objective@#Adequate methods of combining T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) to assess complete response (CR) to chemoradiotherapy (CRT) for rectal cancer are obscure. We aimed to determine an algorithm for combining T2WI and DWI to optimally suggest CR on MRI using visual assessment. @*Materials and Methods@#We included 376 patients (male:female, 256:120; mean age ± standard deviation, 59.7 ± 11.1 years) who had undergone long-course CRT for rectal cancer and both pre- and post-CRT high-resolution rectal MRI during 2017– 2018. Two experienced radiologists independently evaluated whether a tumor signal was absent, representing CR, on both post-CRT T2WI and DWI, and whether the pre-treatment DWI showed homogeneous hyperintensity throughout the lesion. Algorithms for combining T2WI and DWI were as follows: ‘AND,’ if both showed CR; ‘OR,’ if any one showed CR; and ‘conditional OR,’ if T2WI showed CR or DWI showed CR after the pre-treatment DWI showed homogeneous hyperintensity. Their efficacies for diagnosing pathologic CR (pCR) were determined in comparison with T2WI alone. @*Results@#Sixty-nine patients (18.4%) had pCR. AND had a lower sensitivity without statistical significance (vs. 62.3% [43/69]; 59.4% [41/69], p = 0.500) and a significantly higher specificity (vs. 87.0% [267/307]; 90.2% [277/307], p = 0.002) than those of T2WI. Both OR and conditional OR combinations resulted in a large increase in sensitivity (vs. 62.3% [43/69]; 81.2% [56/69], p < 0.001; and 73.9% [51/69], p = 0.008, respectively) and a large decrease in specificity (vs. 87.0% [267/307]; 57.0% [175/307], p < 0.001; and 69.1% [212/307], p < 0.001, respectively) as compared with T2WI, ultimately creating additional false interpretations of CR more frequently than additional identification of patients with pCR. @*Conclusion@#AND combination of T2WI and DWI is an appropriate strategy for suggesting CR using visual assessment of MRI after CRT for rectal cancer.

Anterior Chest Wall Involvement in Spondyloarthritis Patients as Detected by Magnetic Resonance Imaging: A Case Series and Literature Review

Magnetic resonance imaging (MRI) plays an important role in diagnosing and classifying axial spondyloarthritis (SpA) and is also useful for appropriate evaluation of disease status owing to its ability to detect inflammation early and reveal structural changes.However, dedicated MRI for the anterior chest wall (ACW) is not routinely considered despite relatively frequent presence of ACW lesions. To date, no study has investigated the imaging findings and clinical features of ACW involvement in Korean SpA patients. Thus, we aimed to show ACW involvement in SpA patients using ACW lesions found by MRI. We describe 20 cases of ACW involvement in which MRI-detected manubriosternal joint lesions. The lesion types included subchondral bone marrow edema, marginal or central bone erosions, subchondral fat infiltration or deposition, and ankylosis, with erosions being the most prevalent finding. We also provide the literature review results describing MRI findings of ACW lesions in SpA patients.

How to Combine Diffusion-Weighted and T2-Weighted Imaging for MRI Assessment of Pathologic Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer?

Objective@#Adequate methods of combining T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) to assess complete response (CR) to chemoradiotherapy (CRT) for rectal cancer are obscure. We aimed to determine an algorithm for combining T2WI and DWI to optimally suggest CR on MRI using visual assessment. @*Materials and Methods@#We included 376 patients (male:female, 256:120; mean age ± standard deviation, 59.7 ± 11.1 years) who had undergone long-course CRT for rectal cancer and both pre- and post-CRT high-resolution rectal MRI during 2017– 2018. Two experienced radiologists independently evaluated whether a tumor signal was absent, representing CR, on both post-CRT T2WI and DWI, and whether the pre-treatment DWI showed homogeneous hyperintensity throughout the lesion. Algorithms for combining T2WI and DWI were as follows: ‘AND,’ if both showed CR; ‘OR,’ if any one showed CR; and ‘conditional OR,’ if T2WI showed CR or DWI showed CR after the pre-treatment DWI showed homogeneous hyperintensity. Their efficacies for diagnosing pathologic CR (pCR) were determined in comparison with T2WI alone. @*Results@#Sixty-nine patients (18.4%) had pCR. AND had a lower sensitivity without statistical significance (vs. 62.3% [43/69]; 59.4% [41/69], p = 0.500) and a significantly higher specificity (vs. 87.0% [267/307]; 90.2% [277/307], p = 0.002) than those of T2WI. Both OR and conditional OR combinations resulted in a large increase in sensitivity (vs. 62.3% [43/69]; 81.2% [56/69], p < 0.001; and 73.9% [51/69], p = 0.008, respectively) and a large decrease in specificity (vs. 87.0% [267/307]; 57.0% [175/307], p < 0.001; and 69.1% [212/307], p < 0.001, respectively) as compared with T2WI, ultimately creating additional false interpretations of CR more frequently than additional identification of patients with pCR. @*Conclusion@#AND combination of T2WI and DWI is an appropriate strategy for suggesting CR using visual assessment of MRI after CRT for rectal cancer.

Anterior Chest Wall Involvement in Spondyloarthritis Patients as Detected by Magnetic Resonance Imaging: A Case Series and Literature Review

Magnetic resonance imaging (MRI) plays an important role in diagnosing and classifying axial spondyloarthritis (SpA) and is also useful for appropriate evaluation of disease status owing to its ability to detect inflammation early and reveal structural changes.However, dedicated MRI for the anterior chest wall (ACW) is not routinely considered despite relatively frequent presence of ACW lesions. To date, no study has investigated the imaging findings and clinical features of ACW involvement in Korean SpA patients. Thus, we aimed to show ACW involvement in SpA patients using ACW lesions found by MRI. We describe 20 cases of ACW involvement in which MRI-detected manubriosternal joint lesions. The lesion types included subchondral bone marrow edema, marginal or central bone erosions, subchondral fat infiltration or deposition, and ankylosis, with erosions being the most prevalent finding. We also provide the literature review results describing MRI findings of ACW lesions in SpA patients.

Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.

Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.

Satisfaction and Difficulties of Korean Family Medicine Resident Training Faculty / 가정의학회지

BACKGROUND: Practitioners of family medicine are essential to primary care practices in Korea. Resident training staffs in Korean family medicine departments have a crucial role in producing well-trained family physicians. This study assesses the aspects of satisfaction and difficulties of Korean family medicine resident training staffs. METHODS: We surveyed the resident training staffs of various Korean family medicine departments using an online survey tool. The survey used in this study was modified from previously used questionnaires. Respondents rated items using a five-point Likert scale and a 0-10 visual analogue scale. RESULTS: The response rate was 43.9% (122/278). The mean satisfaction score with regard to current family medicine residency programs was 7.59 out of 10. Resident training staffs found the administrative aspects of their role to be the most difficult. There were considerable differences in the reported difficulties of resident training according to the differing characteristics of each staff member, including age, sex, type of hospital, number of staff members, role as chief, and duration of staff. Most respondents (91.9%) cited a need for faculty development programs. CONCLUSION: Korean family medicine resident training staffs need faculty development programs for the improvement of resident training. For the strengthening of core competencies among resident training staffs, faculty development programs or courses should be designed and implemented in Korea.

The Safety of Elective Colorectal Surgery without Mechanical Bower Preparation / 고신대학교의과대학학술지

OBJECTIVES: To reduce the risk of postoperative infectious complications and anastomotic leakage in colorectal surgery, preoperative mechanical bowel preparation (MBP) is performed routinely. The aim of this study was to evaluate the safety of primary anastomosis in elective colorectal surgery without MBP. METHODS: From Jan. 2005 to Dec. 2006, three hundred and seventy-nine patients of elective colorectal surgery with primary anastomosis were performed with MBP in 352 cases (Prep group) and without MBP in 24 cases (Non-prep group). For preoperative MBP, 4 liters of polyethylene glycol solution was administered. Postoperative infectious complications and other morbidity were reviewed with medical records and prospectively collected data. RESULTS: Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (wound infection, anastomotic leak) was 2.9 % in the Prep group and 9 % in the Non-prep group (P > 0.05). Anastomotic leak occurred in nine patients (2.6%) in the Prep group and one (4.5%) in the Non-prep group. CONCLUSIONS: The incidence of infectious complications after elective colorectal surgery without MBP did not differ significantly compare to that with MBP. However, prospective, randomized clinical trial is needed to assess the safety of primary anastomosis in elective colorectal surgery without MBP.

Late Complications after Preoperative Chemoradiation for Rectal Cancers / 고신대학교의과대학학술지

OBJECTIVES: To compare the late complications after operations for rectal cancers with and without preoperative chemoradiation. METHODS: From January 2003 to December 2005, 55 patients underwent operation after preoperative chemoradiation for adenocarcinoma of the rectum. All of them received the full scheduled dose of radiation with concurrent chemotherapy. The interval between preoperative chemoradiation and surgery was 4-6 weeks. 47 patients who had tumors below 8 cm from the anal verge were enrolled into the study group (CRT group). During same period, we selected 153 patients who had adenocarcinoma of the rectum below 8cm from the anal verge, underwent surgery alone without postoperative radiotherapy non-CRT group). We compared the early and the late postoperative complications between the CRT group and the non-CRT group. RESULTS: Of the late complications, the incidence of anastomotic stricture was significantly higher in the CRT group (P = 0.018). The incidence of anal stricture was higher in the CRT group (P = 0.164). In the CRT group, 3 cases (17.6%) had failed to preserve the anal function due to moderate or severe anal stricture. Of the 3 cases, protective ileostomy was persistent in 2 cases, colostomy was performed in one case. Otherwise, the late complications of the CRT group were intestinal obstruction in 2 cases (4.3%), lymph edema in 2 cases (4.3%). CONCLUSION: In CRT group, failure of anal function preservation due to anastomotic stricture or anal stricture was more common and serious than non-CRT group. We emphasize the need for careful management for postoperative anal stricture after preoperative chemoradiation.

Transvaginal Ultrasonographic Assessment of Cervical Length for Prediction of Preterm Delivery within 7 Days in Patients with Preterm Labor / 대한주산의학회잡지

PURPOSE: To investigate the usefulness of transvaginal ultrasonographic measurement of cervical length in patients with preterm labor for prediction of preterm delivery within 7 days. METHODS: Cervical length was measured by transvaginal ultrasound in 140 women with singleton pregnancies presenting with preterm labor and intact membranes from 24(+0) to 33(+6) weeks of gestation. Other potential predictive factors, such as Bishop score, previous history of preterm delivery, and parity were assessed. RESULTS: The mean gestational age at presentation was 30.5+/-14.7 (range, 24.0 to 33.6) weeks and the mean cervical length was 29.0+/-0.9 (range, 31.0 to 52.1) mm. Delivery within 7 days occurred in 7.9% (11/140). Receiver-operating characteristics (ROC) curves established a cervical length of 25 mm as the most relevant cut off level for prediction of delivery within 7 days. Interval between admission and delivery was significantly short when ultrasonographic cervical length was less than or equal to 25 mm. Logistic regression analysis demonstrated that the significant independent risk factors were cervical length < or =25 mm (OR: 24.64, 95% Cl: 2.97~204.20, P=0.003). CONCLUSION: Ultrasonographic cervical length measurement is a useful tool for prediction of progression to preterm delivery within 7 days with patients with preterm labor.

Intestinal Obstruction Caused by Anisakiasis

Anisakiasis occurs after ingestion of raw marine fish or inadequately cooked saltwater fish or squid containing nematode larvae of the Anisakis genus. Ingested larvae invade the gastrointestinal wall and cause clinical symptoms, including cramping, abdominal pain, nausea, vomiting, and various gastrointestinal lesions. Although enteric Anisakiasis is extremely rare, it can induce intestinal obstruction. Here, we report a case of intestinal obstruction caused by Anisakiasis, along with a brief review of the relevant literature.

The Clinicopathologic Characteristics of Neuroendocrine Tumor of the Stomach

PURPOSE: The goal of this study was to review the clinicopathologic characteristics of neuroendocrine tumor (NET) of the stomach. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 13 patients who were diagnosed with neuroendocrine tumor from January 1999 to August 2007 at Kosin Medical Center; 4,159 gastric cancer patients were treated surgically during the same time. The average follow up period was 14.3 months. RESULTS: The majority of 13 patients were men (male-female ratio: 11:2) and the average age of patients with NET was 59.4 years (range: 42~72 years). The presenting symptoms were mostly epigastric pain and soreness. The tumor was limited to the mucosa or submucosa in two cases, and the tumor extended beyond the muscle layer in 11 cases. The mean size of the tumor was 7.0 cm, ranging from 0.7 cm to 15 cm. The type of the NEC (according to the WHO classification) was type 3 for eight patients, type 4 for four patients and type 1 for one patient. Regional lymph node metastasis was noted in 11 patients. Four cases showed recurrence of disease and the site of recurrence included liver in two patients, multiple organs (including the peritoneum and lung) in one patient and multiple organs (including liver, pancreas and duodenum) in one patient. The recurrent cases were type 3 and type 4 and the average survival period of the recurrent patients was 12.8 months. CONCLUSION: The majority of neuroendocrine tumors of the stomach were at an advanced stage at the time of diagnosis. These tumors frequently recurred in the liver and they have a poor prognosis.

Carcinoid Tumor Arising within a Tailgut Cyst: A Case Report

Tailgut cysts are rare congenital lesions. They are believed to develop from remnants of the embryonic hindgut. Malignancy in tailgut cyst is extremely unusual. We experienced a case of a carcinoid tumor arising within a tailgut cyst at the presacral space. A 40-year-old woman was admitted for acute anal pain. Digital rectal examination revealed a 2-cm-sized submucosal tumor in the posterior midline rectum 4 cm above the anal verge. On sigmoidoscopic examination, the overlying rectal mucosa seemed to be intact. We performed a transanal incisional biopsy. The pathological diagnosis of the tumor biopsy revealed a malignant neuroendocrine tumor. The patient underwent an abdominoperineal resection. The tumor proved to be mutilocular cysts with a solid component. The cysts were diagnosed as tailgut cysts that were lined by a variety of epithelial types, including inner columnar cells, outer cuboidal cells, and transitional cells. The solid component in the cysts was confirmed as a carcinoid tumor on microscopic examination. Six months after the operation, she was found to have liver and brain metastases.

Study for umbilical cord plasma leptin in gestational diabetes and normal pregnancy / 대한산부인과학회지

OBJECTIVE: To compare umbilical cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects and to evaluate the regulation of leptin in GDM. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human Leptin RIA kit; Linco Research, Inc. USA). We compared cord plasma leptin level between gestational diabetes (n=18 women) and control pregnancies (n=21 women). RESULTS: Maternal weight, fetal birth weight, Ponderal index and placental weight were significant variables among the demographic variables. There was statistical difference in cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects (Control subjects: 4.8 [3.7-7.9]ng/mL, GDM women: 8.0 [6.6-11.9]ng/mL, P=0.022). There was also statistical difference in the ratio between cord plasma leptin level and birth weight (Control subjects: 0.001 [0.001-0.002]ng/mL/gm, GDM women: 0.002 [0.002-0.003]ng/mL/gm (P=0.022)), and between cord plasma leptin level and Ponderal index (Control subjects: 0.280 [0.217-0.579], GDM women: 0.605 [0.452-1.005], (P=0.008)). There was no difference in gender. CONCLUSION: We found significant difference in umbilical cord plasma leptin level and adjusted leptin level for fetal birth weight, Ponderal index and placental weight between infants of mothers with gestational diabetes and infants of control subjects. It is suggested that umbilical cord plasma leptin is produced by fetal fat tissue, but it is more complicatedly regulated by placenta and other factors in gestational diabetes.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Normalization of serum SCC-Ag by surgical removal of maxillary inverted papilloma during follow-up of cervical carcinoma: a case report / 부인종양

Squamous cell carcinoma antigen (SCC-Ag) is a well-established tumor marker for monitoring recurrence of squamous cell carcinoma of the cervix. However, serum levels of SCC-Ag could be elevated by some benign conditions not to speak of squamous cell malignancies other than cervical carcinoma. Sinonasal inverted papilloma is one of benign tumor which may elevate serum SCC-Ag level. We experienced a case of cervical carcinoma patient whose serum level of SCC-Ag was not normalized in spite of combination chemotherapy until surgical removal of maxillary inverted papilloma detected by PET/CT.

Correlation between Ultrasonographic Findings of Endometrioma and Endometriosis Stage and Recurrence / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate of correlation between ultrasonographic findings of endometrosis and endometriosis stage and recurrence. METHODS: We reviewed medical records of fifty-nine patients who admitted the department of Obstetrics and Gynecology of Sanggye Paik Hospital from April 1998 to June 2004 and were surgically confirmed endometriosis stage 3-4. GnRH agonist was injected every 4 weeks after the first injection following initial operation and a total of six doses were injected to a patient. We performed ultrasonographic examination of pre- and post-operation at an interval of 3 or 6 months. The endometriotic ultrasonographic findings were classified into three group; low-level internal echo (LIE), LIE and septation, LIE and hyperechoic wall foci. The correlation between ultrasonographic finding of endometrioma and endometriosis stage and recurrence were analyzed by Fisher's exact test and Pearson's chi-square test. RESULTS: The follow-up periods after operation were about 11.9 months. Typical ultrasonographic findings of endometrioma were observed on 50 of 59 patients, diagnostic performance of ultrasound in the detection of endometrioma had a 84.7% sensitivity in this study. In 50 cases, 48% (n=24) had a only low-level internal echoes, 32% (n=16) had a low-level internal echoes and multiple septation, 20% (n=10) had a low-level internal echoes and hyperechoic wall foci. The most common ultrasonographic findings were LIE (50%) in stage 3, LIE and septation (33.3%) in stage 4. During follow-up we observed ultrasonographic recurrence in 6 (10.2%) cases. There were no statistically significant correlation between ultrasonographic finding and endometriosis stage or recurrence. CONCLUSION: Ultrasound is a convenient and reliable method for diagnosis of endometrioma. But, it appears that ultrasonographic findings of endometrioma not correlate with endometriosis stage or recurrence. Further long term follow-up studies in large scale is needed for correlation between ultrasonographic findings of endometriosis and clinical significance.

Epidemiologic Analysis of Sexual Assault Victims in Northeast Area of Seoul / 대한산부인과학회지

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.