Résumé
OBJECTIVE: Although a great deal of knowledge accumulated with regard to the causes and epidemiologic features of cervical cancer, primary prevention has not been particularly effective to date. Most efforts with regards of control of cervical cancer have been directed toward secondary prevention with cytologic smears in a screening program. The purpose of this study was to know the cervical smear histories in the women with neoplasia of uterine cervix at present. MATERIALS AND METHOD: Between June, 1993 and October, 1996, seventy women with invasive cervical carcinoma and eighty-seven women with cervical intraepithelial neoplasia(CIN) were interviewed about cervical smear histories to assess the frequencies of past smear at the Soonchunhyang University Hospital. RESULTS: The results were follows: 1. The mean age of the women with invasive cervical cancer and CIN were 55+/-9 and 42+/-11, respectively. 2. Of the 70 cases of cervical cancer, 61%(43/70) has not been screened, compared with 43%(37/87) in cases of CIN. 3. The mean ages at first smear in the cases of previous smear were 42+/-6 of 27 cancers, 37+/-7 of 50 CINs. The gap between the age at the first smear and the age at diagnosis were about 6 years in cases of cervical cancers, about 5 years in cases of CIN. 4. The most common symptom in cervical cancers was vaginal bleeding or postcoital bleeding(57%). Although 13%(9/70) were discovered during screening without symptom in the women with cervical cancers, 58%(52/87) were diagnosed incidently during screening in CIN. 5. Pap smear numbers before diagnosis were strongly associated with age and stage. Among women diagnosed with invasive cancer under the age of 49, 75% had at least one cervical smear. But, all women with cervical cancer over age of 65 have not been screened. Unscreened rates of stage I, II, III, and IV were 34%, 78%, 85% and 83% respectively. 6. Among 38 cases who had undergone radiation therapy, 82%(31/38) had not been screen in contrast to 38%(12/32) in the women who had undergone radical surgery. 7. Among women with previous smears in the cervical cancer, 20%(14/70) have been screened within 1year. CONCLUSION: It is likely to diagnosis cervical cancer who had normal papanicolau smear in recent. So papanicolau smear is examined carefully and other adjunctive test is help to diagnosis cervical cancer exactly, for example cervicography, HPV testing.
Sujets)
Femelle , Humains , Dysplasie du col utérin , Col de l'utérus , Diagnostic , Dépistage de masse , Prévention primaire , Prévention secondaire , Tumeurs du col de l'utérus , Hémorragie utérine , Frottis vaginauxRésumé
OBJECTIVE: To determne whether abnormal results of doble saeening tests for Down syndrome with MSAFP and free B-hCG are associated with adverse pregnancy outcome. METHODS: Between October 1994 and September 1997, 205 among 1731 who were screened had increased risk for Down screening program of CIS biointernational, Fetuses with Chromosomal abnormality or congenital anomalies and less than 35 years of maternal age were excluded from this study. Down syndrome screening test was performed between 14-22 weeks of gestation. RESULTS: Of 1731 women, 205 (13.4%) had increased Down syndrome risk. The pregnancy outcome of women with increased Down syndrome risk were compared with those of women without such risk There were no significant difference in the incidence of preterm labor (6[2.9%] vs 112[7.3%)), premature rupture of the membranes (2[0.9%] vs 56[3.6%]), pregnancy induced hypertension (2[0.9%] vs 36[2.3%]), abruptio placentae (0[0%] vs 2[0.1%]), low birth weight (2[0.9%] vs 21[1.3%]), oligohydramnios (4[1.9%] vs 10[0.6%]), intrauterine fetal death (0[0%] vs 2[0.1%]). CONCLUSION: False positive results of Down syndrome screening test in the 2nd trimester do not appear to be associated with adverse pregnancy outcome. But there are statistically significant increases of adverse pregnancy outcome in wemen with elevation of MSAFP or elevation of free B-hCG.
Sujets)
Femelle , Humains , Nouveau-né , Grossesse , Grossesse , Hématome rétroplacentaire , Aberrations des chromosomes , Syndrome de Down , Mort foetale , Foetus , Hypertension artérielle gravidique , Incidence , Nourrisson à faible poids de naissance , Dépistage de masse , Âge maternel , Membranes , Travail obstétrical prématuré , Oligoamnios , Issue de la grossesse , RuptureRésumé
OBJECTIVE: To evaluate the frequency and obstetric consequences of women with uterine anomalies and correlation between obstetric consequence and congenital uterine anomalies. Materials and METHODS: A retrospective study was made on 65 patients with uterine anomalies in order to evaluate the obstetric consequence at department of obstetrics and gynecology, Soonchunhyang University Hospital from January 1994 to June 1997. The diagnosis of uterine anomalies was made with hysterosalpingogram or ultrasonogram, or at the time of cesarean section. The uterine anomalies were classified according to the classification of Buttram and Gibbons and compared the pregnancy outcome for each classification. The obstetric consequences were divided into preterm delivery, premature rupture of membranes, intrauterine growth restriction, and abnormal presentation of fetus. Statistical analysis was carried out using chi-square test, the significance was defined as P< 0.05. RESULTS: 1. The incidence of uterine anomalies accounted for 1.04% (65/6,250 deliveries). 2. The most common uterine anomalies were class III (Uterine didelphys, 47.7%). 3. We noted preterm birth rate (16.9%), premature rupture of membranes rate (20%), intrauterine growth restriction rate (9.2%) in 65 patients. 4. The rate of breech presentation was 41.5% and the mean birth weight was 2,747 gram. 5. When uterine anormalies were present, the incidence of obstetric consequences was significantly increased. CONCLUSION: We concluded that congenital uterine anomalies were closely related to obstetric consequences, such as preterm, breech presentation, intrauterine growth retardation.
Sujets)
Femelle , Humains , Grossesse , Poids de naissance , Présentation du siège , Césarienne , Classification , Diagnostic , Retard de croissance intra-utérin , Foetus , Gynécologie , Hylobates , Incidence , Membranes , Obstétrique , Issue de la grossesse , Naissance prématurée , Études rétrospectives , Rupture , ÉchographieRésumé
PURPOSE: Serum squamous cell (SCC) antigen levels were examined in uterine cervix cancer undergoing radiation therapy, and authors analyzed the relationship between SCC antigen levels and treatment results. MATERIALS AND METHODS: This is a retrospective study of 181 cervical carcinoma patients who received radiotherapy and examined serial serum SCC antigen from 1991 to 1997 at Soonchunhyang University Hospital. One hundred and eighteen patients underwent SCC antigen evaluation at diagnosis The relationship between the serum tumor marker level and disease free survival, recurrence pattern, and other prognostic factors were analyzed according to various statistical methods. RESULTS: The positivity rate (initial serum value above 2.5 ng/ml) was increased with FIGO stage (IB-IIA 57% to IV 91%) and more discriminative than cutoff value of 1.5 ng/ml. Five year disease free survival rates for the stage IB-IIA, IIB, III and IV were 79.2%, 68.7%, 33.4% and 0%, respectively. The 5-year disease free survival rate for patients with serum SCC antigen levels above 5.0 ng/ml was 34% versus 55~62% for patients with normal range (<1.5 ng/ml) or mildly elevated levels (1.5~5.0 ng/ml). Rising SCC antigen levels preceded the clinical detection of disease by a mean of 4.8 months (range 1~13 months). Negative linear corelation was observed between initial SCC antigen levels and relapse free survival (r=-0.226), and by multivariate analysis, initial SCC antigen level had a large impact on the relapse free survival. CONCLUSIONS: SCC antigen assay is a useful aid to predict the prognosis of squamous cell carcinoma of the uterine cervix and to detect recurrence.
Sujets)
Femelle , Humains , Carcinome épidermoïde , Col de l'utérus , Diagnostic , Survie sans rechute , Analyse multifactorielle , Pronostic , Radiothérapie , Récidive , Valeurs de référence , Études rétrospectives , Tumeurs du col de l'utérusRésumé
Struma ovarii is a monodermal teratoma composed totally or in overwhelming proportion of thyroid tissue. It is uncommon and accounts for 1% to 3% of benign teratomas of ovary. Grossly, they are encapsulated neoplasms, several centimeters in diameter and have a red, shiny, and meaty surface. Microscopically, the tumor is composed of mature thyroid tissue consisting of various sizes, lined by a single layer of columnar or flattened epithelium. The clinical behavior is benign, and simple excision is adequate treatment. We had experienced two cases of struma ovarii arising in the left ovaries. So we report above cases with brief review of literatures.
Sujets)
Femelle , Épithélium , Ovaire , Goitre ovarien , Tératome , Glande thyroideRésumé
A considerable body of evidence has been accumulated suggesting that invasive squamous cell carcinoma develops from cervical intraepithelial neoplasia(CIN). Most women with invasive cancer of the cervix are from lower socioeconomic groups, have begun heterosexual activity early in life, marry early, are multiparous, and have many sexual partners. Although the epidemiology of the cervical cancer is known well, the pathogenesis of the cervical cancer from CIN is subtle yet. Apoptosis, including the programmed cell death, is important event in normal cell turnover and maintenance of adult tissues. Apoptosis exerts a homeostatic function in relation to tissues dynamics, as the steady state of continuously renewing tissues achieved by a balance between cell replication and cell death. The specific labelling of nick ends of fragmented DNA was used to see the apoptotic cells from normal epithelium of the cervix to invasive cervical cancer. The apoptotic cells were found normally in the parabasal layer of the epithelium. As the grade of CIN increase, the apoptotic cell were found in superficial of the cervix and number of the apoptotic cell were increased. In the cervical cancer, the apoptotic cell were found in the cancerous tissues more than in the normal epithelium. This results suggest that the cell proliferation is more important than the inhibition of the apoptosis in the carcinogenesis of the cervical cancer.
Sujets)
Adulte , Femelle , Humains , Apoptose , Carcinogenèse , Carcinome épidermoïde , Mort cellulaire , Prolifération cellulaire , Col de l'utérus , ADN , Épidémiologie , Épithélium , Hétérosexualité , Partenaire sexuel , Tumeurs du col de l'utérusRésumé
Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always surgical, and all defects. The managements is always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments. Massive eversion of the vagina can be treated by a variety of transvaginal and transamdominal surgical technique. In most instances a transvaginal approach is useful. If strong cadinal and uteroscral support in not available fiocation of the vginal vault to the sacrospinous ligment is useful. In 1987, Miyazaki introduced his Miya Hook ligature carrier. With this instrume nt, introduction of the needle became safer and easier than with the Deschamp aneurysm needle. We had experienced two cases of massive eversion of vagina after the total abdominl hyst erectomy who were treated succesfully with sacrospinous ligement fixation by using Miya Hook. We report above two cases and review briefly.
Sujets)
Femelle , Humains , Anévrysme , Fascia , Hystérectomie , Ligaments , Ligature , Aiguilles , VaginRésumé
PURPOSE: Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. METHODS AND MATERIALS: Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcioma in situ (38 cases), severe dysplasia(2), myoma(6), uterine bleeding (4), uterine prolapse (2), and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy form August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients reveived ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. RESULTS: Overall 5-year survival rate and relapse-free survival rate were 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively. There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cncer (stage IA) had no treatment related failure. Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. CONCLUSION: Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy. Survivals for patients with gross disease remained after inappropriate hysterectomy was poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.
Sujets)
Femelle , Humains , Épithélioma in situ , Col de l'utérus , Diagnostic , Études de suivi , Hystérectomie , Lymphadénectomie , Myome , Radiothérapie , Radiothérapie adjuvante , Récidive , Études rétrospectives , Taux de survie , Échec thérapeutique , Tumeurs du col de l'utérus , Hémorragie utérine , Prolapsus utérinRésumé
Cellular oncogenes are expressed as an intrinsic part of the transformed or neoplastic phenotype. More than 60 of the known cellular oncogenes play a specific role in normal cellular development and differentiation. To examine the correlation between ras oncogene expression and the development of cervical cancer, this study investigated the reactivity of cervical intraepithelial neoplasia(CIN) and carcinoma of the uterine cervix by using anti-ras P21 mouse monoclonal antibody. The expression of ras oncogene significantly increased with the grade of malignancy from 11% in severe dysplasia, 30% in carcinoma in situ, 43% in microinvasive carcinoma, to 53% in invasive cancer. The expression of ras oncogene was not correlated with histologic type, tumor size, and nodal status of cervical cancer. It was concluded that expression of ras oncogene is related to early phase of carcinogenesis and tumor invasion of carcinoma of the uterine cervix.
Sujets)
Animaux , Femelle , Souris , Carcinogenèse , Épithélioma in situ , Col de l'utérus , Gènes ras , Oncogènes , Phénotype , Tumeurs du col de l'utérusRésumé
OBJECTIVE: The objective of this study were to clarify the significance of PCNA and DNA ploidy as a possible parameter of the prognosis in squamous cell carcinoma of the uterine cervix. STUDY DESIGN: Women with the diagnosis of cervical cancer operated between January 1987, and July 1991, composed the study group(n=35) in this case-control group. Among these 35 patients.In theese patients we chose the patients with complete follow up treatment. Also we employed 7 control paraffin-embedded cervical specimens without any specific pathologic lesions for the comparison. Immunohistochemical staining to identify PCNA was applied to case of paraffin section and PCNA indices was obtained. DNA analysis was done by using flow cytometry and S-phase fraction and DNA ploidy were obtained. RESULT: The results were summarized as follows. 1. S-phase fraction were 20+/-7% in cervical cancer and 16+/-11% in control group. There were no statistical difference. Aneuploid ratio were 26%(9/35) in cervical cancer and 0%(0/7) in control group. There were statistical difference. PCNA indices were 45+/-6% in cervical cancer and 5+/-4% in control group. There were statistical difference. 2. There were no statistical difference in PCNA indices between large cell keratinizing type, and large cell nonkratinizing type of cervical cancer. 3. According to lymph node metastasis, there were no statistical difference in PCNA indices between positive group and negative group.4. According with various pathologic parameters, recurrence rate was hihger in cases of parametrial involvement. 5. The correlation of coefficient was 0.747 between PCNA indices and S-phasd fraction that is a significant relationship.6. According to recurrence, there were no statistical difference in S-phase fraction, aneuploidy and PCNA indices between group of recurrence and no recurrence.7. There were no statistical difference between 20%, group of S-phase, aneuploid and 60%, group of PCNA index in view of recurrence rate. conclusion: That is a significant relationship between S-phase fraction and PCNA indices, But, there are no statictical significance of PCNA indices, DNA ploid and a prognostic factor. So, that is a limitation in PCNA index DNA ploid when it was used as as prognostic parameter of nterine cervical cancer.
Sujets)
Femelle , Humains , Aneuploïdie , Carcinome épidermoïde , Études cas-témoins , Col de l'utérus , Diagnostic , ADN , Cytométrie en flux , Études de suivi , Noeuds lymphatiques , Métastase tumorale , Paraffine , Ploïdies , Pronostic , Antigène nucléaire de prolifération cellulaire , Récidive , Tumeurs du col de l'utérusRésumé
No abstract available.