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Objective The aim of this study was to ascertain the relationships between perspective-taking, empathic concern, and self-rating of empathy as a physician among medical students. Methods This study analyzed the questionnaire responses of 152 medical students enrolled in Ajou University School of Medicine, Suwon, Republic of Korea, in 2018. As measurement instruments, the authors applied the Interpersonal Reactivity Index (IRI) and Korean Student Version of the Jefferson Scale of Physician Empathy (Korean JSPE-S), and then examined participant characteristic variables based on the obtained data and conducted subsequent correlation analyses of subscales, one-way ANOVA, and regression analyses. Results Medical students with clinical clerkship experience demonstrated higher levels of perspective-taking and empathy as physicians than did students without experience. Moreover, perspective-taking and empathic concern were significant predictors of medical students’ empathy as physicians in the regression model. Conclusions Medical students with higher scores in perspective-taking and empathic concern demonstrated higher levels of perception regarding the necessity and importance of empathy as a physician in patient-physician relationships. Therefore, in actual medical situations with patient-centered therapy, to enhance the levels of physician empathy, medical education should focus on the understanding of other persons’ opinions and interpersonal interactions accompanied by empathic concern.

Background Medical school faculty members have been reported to be highly likely to suffer burnout. Research is being conducted on professional self-concepts as a factor that relieves burnout in many professions. However, there is a paucity of data on the relationship between professional self-concept and burnout among medical school faculty. Professional self-concept means a perception of oneself as a member of the profession. It influences an individual’s thoughts, actions, and emotions. The more positive the professional self-concept, the higher is the self-esteem in the profession, which can contribute to reducing burnout. This study aimed to investigate the professional self-concept and incidence of burnout among medical school clinical faculty members, and to ascertain the factors that affect professional self-concept with respect to burnout. Methods A total of 68 clinical faculty members at the Ajou University School of Medicine completed a modified form of the professional self-concept scale and the Maslach Burnout Inventory. We undertook the following statistical analyses: a descriptive analysis to understand the distribution of participants, correlation analysis to indicate associations between variables and a multiple regression analysis to examine the influence of gender, position, and specialty on professional self-concept and burnout, and the effect of each subscale of professional self-concept on burnout. Results As professional self-concept increases, burnout decreases. There was no significant difference between professional self-concept and burnout with respect to gender or field of medical specialty, while a significant difference was observed across faculty position levels. Additionally, the professional self-concept subscale, which included satisfaction and communication skill, was found to significantly affect burnout. Conclusions This study shows that professional self-concept affects burnout. Through these results, we can infer that professional self-concept functioned to protect medical school faculty from burnout. This may be a strategy that fortifies the professional identity of medical school faculty, and it is suggested that educational programs that are directed toward this goal be established.

Congenital muscular torticollis (CMT) is known to concur with some conditions such as developmental dysplasia of the hip or brachial plexus injury, which gives us some insights for pathogenesis of CMT. Although clavicular fracture is the most common fracture in newborns, little is known about concurrence of CMT and clavicular fracture. Our clinical experience led us to realize that concurrence of CMT and clavicular fracture tended to occur on the contralateral side for each other rather than the ipsilateral side. This study aimed to verify contralateral concurrence of CMT and clavicular fracture. This is a retrospective cohort study in a tertiary hospital, including 996 subjects with CMT. Concurrent clavicular fracture was found in 20 of 996 subjects with CMT, with the concurrence rate being 2.01%. Concurrent clavicular fracture and clavicular fracture occurred on the contralateral side for each other in 18 subjects (90%) rather than the ipsilateral side. This contralateral concurrence between side of CMT and clavicular fracture was significant (P = 0.001), with an odds ratio of 81 (P = 0.0032). Concurrent clavicular fracture and clavicular fracture seem to occur significantly more on the contralateral side for each other. Underlying mechanism for consistent contralateral concurrence needs to be verified in the near future.

Purpose Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept. Methods This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables. Results We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation. Conclusion Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.

Objective: To evaluate the effectiveness of a modified Palva flap used for external auditory canal reconstruction and mastoid obliteration in canal wall down mastoidectomy. Methods: We retrospectively analyzed patients who underwent canal wall down mastoidectomy with tympanoplasty using modified Palva flap. All patients underwent pure tone audiometry and temporal bone computed tomography (CT) before surgery, and the same tests were performed in the first year after surgery. The external auditory canal volumes were calculated by summing the areas of each section selected in temporal bone CT. For each patient, the ratio of external auditory canal volume was calculated from CT taken before and after surgery. Results: The mean of external auditory canal volume after canal wall down with a modified Palva flap was about 1.4 times larger than before surgery. The modified Palva flap is effective for the reconstruction of the external auditory canal. Both pure tone audiometry level and air-bone gap showed statistically significant improvement after surgery ( Ps = .001 and .002, respectively). Conclusions: The external auditory canal volume slightly increased, but the status of mastoid obliteration was well maintained 1 year after surgery. The modified Palva flap used in this study is an easy and effective method in external auditory canal reconstruction and mastoid obliteration.

Purpose The purpose of this study was to examine the relationship among academic self-efficacy, socially-prescribed perfectionism, and academic burnout in medical school students and to determine whether academic self-efficacy had a mediating role in the relationship between perfectionism and academic burnout. Methods A total of 244 first-year and second-year premed medical students and first- to fourth-year medical students were enrolled in this study. As study tools, socially-prescribed perfectionism, academic self-efficacy, and academic burnout scales were utilized. For data analysis, correlation analysis, multiple regression analysis, and hierarchical multiple regression analyses were conducted. Results Academic burnout had correlation with socially-prescribed perfectionism. It had negative correlation with academic self-efficacy. Socially-prescribed perfectionism and academic self-efficacy had 54% explanatory power for academic burnout. When socially-prescribed perfectionism and academic self-efficacy were simultaneously used as input, academic self-efficacy partially mediated the relationship between socially-prescribed perfectionism and academic burnout. Conclusion Socially-prescribed perfectionism had a negative effect on academic self-efficacy, ultimately triggering academic burnout. This suggests that it is important to have educational and counseling interventions to improve academic self-efficacy by relieving academic burnout of medical school students.

Objective To analyze the clinical characteristics and evaluate the surgical outcomes of carcinoma of the external auditory canal (CEAC). Materials and methods Overall, 31 patients from four multicenter hospitals, who were diagnosed and surgically treated for CEAC in 2009-2014, were enrolled for this retrospective study. Medical records were reviewed to determine cancer stage according to the Pittsburgh classification. Clinical data of age, sex, site, initial symptoms, surgery extent, postoperative complications including recurrence, follow-up period, and current patient status were collected for analysis. Five-year cumulative survival rate was obtained using Kaplan-Meier method. Results At initial diagnosis, 22 patients were in the early stages (stage I: 15; stage II: 7) and 9 patients were in the advanced stages (stage III: 1; stage IV: 8). Lymph node metastasis was present in 5 patients and distant metastasis in 2. Of the 31 patients, 4 patients died (stage II: 1, stage IV: 3) during the follow-up period. Early-stage patients showed 100% 5-year estimated cumulative survival rate, whereas the advanced-stage patients showed 5-year estimated survival rate of 53.6% (p=.006). The overall survival rate of all enrolled patients was 90.3%. Although 5-year estimated disease-free survival rate of stage I was 100.0%, that for stage II was low at 30.0% because of considerable recurrences. Conclusion The results of this multicenter study suggest that more aggressive treatment modality, including adjuvant therapy, is necessary for patients with CEAC with Pittsburgh stage II or more.

Objective The most common birth-associated head injuries during vaginal delivery are cephalhematomas and subgaleal hematomas. Cranial injuries are rarely encountered. The neonate cranium is soft and pliable, and greenstick skull fractures (GSFs) are expected to be more frequent than linear or depressed fractures, but they are extremely difficult to detect with simple skull radiography. As a result, no reports have been issued on this topic to date. Recent reports suggest that technological advances in 3-dimensional (3D) computed tomography (CT) have successfully enhanced the diagnostic accuracy for cranial fractures. The authors researched the types and characteristics of GSFs and the diagnostic accuracy of 3D CT for cranial fractures in neonates. Methods The simple skull radiographs and 3D CT images of 101 neonates were retrospectively evaluated and compared with respect to diagnosis of cranial fractures, and skull GSFs were classified on the basis of 3D CT findings into 5 types depending on multiplicity and location. Results 3D CT detected 88 cases of cranial fractures, that is, 89 GSFs, 4 combined GSFs and linear fractures, and 3 combined GSFs and depressed fractures. The diagnostic rate of 3DCT was 91% and this was significantly higher than the 13% rate of simple skull radiographs (P Conclusions GSFs rather than linear fractures were found to account for most cranial injuries among neonates. The diagnostic accuracy of 3D CT was considerably superior than simple skull radiography, but the high radiation exposure levels of 3D CT warrant the need for development of a modality with lower radiation exposure.

The most important predictive factor of facial nerve outcome in surgery for small-sized vestibular schwannoma (VS) is the adhesion between the tumor and the facial nerve.To compare the facial nerve outcomes between middle cranial fossa (MCF) and translabyrinthine (TL) approaches, and to analyze the preoperative and intraoperative factors influencing facial nerve outcome after small VS surgery in our neurotologic department.A total of 29 patients were retrospectively analyzed, with 16 in the MCF group and 13 in the TL group. Facial function was serially evaluated according to the House-Brackmann classification at 7 days, 1 month, 3 months, 6 months, and 1 year postoperatively. The effects of variables such as the surgical approach, tumor size, nerve origin, extrameatal extension, intraoperative tumor adhesion to the facial nerve, and facial nerve displacement were determined.Early and late facial nerve outcomes showed no significant correlation with surgical approach, tumor origin, tumor size, extrameatal extension, or facial nerve displacement pattern. However, a significant correlation was observed with tumor adhesion to the facial nerve and facial nerve outcomes.

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.

Objectives We performed this study to introduce our minimal supra-auricular approach for the surgical management of a preauricular sinus (PAS) and to evaluate the advantages of this drainless technique. Study design This was a retrospective study. Setting The study was done in a tertiary referral center. Methods We enrolled 94 patients (101 ears) with a PAS who underwent surgical treatment via a minimal supra-auricular approach performed by one surgeon between April 1999 and May 2010. After removing the specimen, meticulous subcutaneous suturing and no drain were used in 83 patients (89 ears) and a postoperative drain was inserted in 11 patients (12 ears). Surgical outcomes of this technique were compared between the groups with and without postoperative drain insertion. Results With a good surgical view and meticulous subcutaneous mattress sutures in our minimal supra-auricular approach for PAS excision, there was no postoperative recurrence or other serious complication. In the drain group, previous operation history was more frequent (P = .010), and the rate of preoperative infection was higher than in the drainless group (P = .018). Postoperatively, a compression dressing was required more frequently (P = .002) and for longer in the drain group (P = .001). The rate of immediate postoperative wound infection was higher in the drain group (P = .003). Conclusion Our drainless minimal supra-auricular approach for the surgical removal of a PAS has advantage in terms of good surgical results of no recurrence and is more comfortable for patients because of the reduced need for a compression dressing. We suggest that this technique is effective and safe for PAS excision.

Aim: The aim of this study was to assess various treatment options in stage IB2 cervical cancer patients. Methods: Between January 1995 and May 2007, 63 patients with stage IB2 were treated by radical hysterectomy (n = 28), primary concurrent chemoradiation (CCRT, n = 16) or radiation therapy (RT, n = 19). Disease-free survival (DFS) and overall survival (OS) were compared between these treatment modalities. Results: The 3-year DFS of the surgical approach group was 67.5% compared to 70.3% of the primary RT/CCRT group (p = 0.603). The 5-year OS of all patients was 75.9%. The 5-year OS of the surgical approach group was 81.6% compared to 76.2% of the primary RT/CCRT group (p = 0.578). Twelve (42.8%) of 28 surgically treated patients had high-risk pathologic factors. Out of 20 premenopausal patients who underwent the surgical approach, ovarian preservation was possible in 13 patients without adjuvant CCRT. Of these 13 patients, 7 patients did not experience disease recurrence and continued normal ovarian function. Conclusion: Both radical hysterectomy and primary RT/CCRT are effective treatment options in IB2 cervical cancer. In addition, the surgical approach can be considered for preserving ovarian function in premenopausal IB2 cervical cancer patients.

The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy.A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of ≥ 31 U/ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis.Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of31 U/ml and deep myometrial invasion by MRI.

Objective. The aims of this study were to compare the diagnostic performance of sonohysterography (SH) with that of magnetic resonance imaging (MRI) in estimation of myometrial invasion and to evaluate the influence of SH on peritoneal cytologic results for patients with endometrial cancer. Methods. Seventy-four patients with endometrial cancer were included. Sonohysterography and MRI were performed before surgery. All patients had complete staging procedures, including peritoneal cytologic analyses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for SH and MRI. Results. The concordance rates of myometrial invasion for SH and MRI were 82.4% and 81.1%, respectively. The sensitivity, specificity, PPV, and NPV for identification of deep myometrial invasion were 64.7%, 87.7%, 61.1%, and 89.3% on SH and 70.6%, 84.2%, 57.1%, and 90.6% on MRI. Two patients (2.7%) were found to have positive results for malignant cells on peritoneal cytologic analyses. Conclusions. Sonohysterography appears to be a useful preoperative method for predicting myometrial invasion, comparable to MRI. Key words: endometrial cancer; myometrial invasion; sonohysterography.

Objective. To evaluate the long-term outcome and ovarian function in premenarchal and adolescent patients with malignant ovarian germ cell tumors after fertility-preserving surgery and adjuvant chemotherapy. Design. Retrospective review of medical records. Setting. Ajou University Hospital, a tertiary care hospital in South Korea. Population. Forty-five patients with malignant ovarian germ cell tumors. Methods. A retrospective analysis of patients with malignant ovarian germ cell tumors was conducted and a statistical analysis was performed. Main outcome measures. There were 9 premenarchal and 16 adolescent patients; the median ages at diagnosis were 7 and 18 years, respectively. All patients were treated with fertility-preserving surgery. Seventeen of the patients received adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (68.0%). There were no disease recurrences or deaths. Of the nine premenarchal patients, eight (88.9%) subsequently had normal menarche. Among the 16 adolescent patients, 15 (93.8%) resumed normal menstruation and 1 had premature ovarian failure. Conclusion. Premenarchal and adolescent patients with malignant ovarian germ cell tumors have excellent survival with fertility-preserving surgery and adjuvant chemotherapy. The majority of these patients can have normal menarche and menstruation.

Objective The aim of this study was to verify whether the Gynecologic Oncology Group (GOG) criteria are valid in a different cohort of patients and to investigate simplified new criteria tailoring adjuvant radiation therapy in patients with intermediate-risk factors after radical hysterectomy. Study design We analyzed the data of 332 patients with FIGO stage IB cervical cancer who underwent radical hysterectomy between 1994 and 2007. Two hundred and twenty-five patients without high-risk factors (lymph node metastasis, parametrial invasion, or positive surgical margins) were identified and were classified into low-risk and high-risk groups according to the GOG criteria and new criteria based on combinations of intermediate-risk factors (large tumor size, deep stromal invasion, lymph-vascular space invasion). We evaluated the prognostic significance of both criteria. Results We identified 140 low-risk patients and 85 high-risk patients in the application of the GOG criteria. Low-risk patients had significantly better disease-free survival (DFS) ( P = 0.001) and overall survival (OS) ( P = 0.013) than high-risk patients. There were 145 low-risk patients and 80 high-risk patients on applying the new criteria. Low-risk patients had significantly better DFS ( P = 0.001) and OS ( P = 0.013) than high-risk patients. The receiver operating characteristic (ROC) curves showed that both criteria had similar performance for predicting which patients would have help from adjuvant therapy. Conclusion This study demonstrated that the GOG criteria were still valid in the different population, the simplified new criteria were convenient to apply in practice, and the performance of the new criteria was as good as the GOGs.

Congenital middle ear cholesteatoma (CMEC) is a rare disease entity in otolaryngology. However, we try to assess the characteristic features and recurrences of CMEC in pediatric patients according to stages, and to determine the value of preoperative computed tomography (CT) scan. Retrospective review of 35 cases of CMEC under the age of 15 yr that had been treated at the tertiary referral center from 1995 through 2006. The main outcome measures were CT findings, surgical findings, recurrence rate and hearing assessment. Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 30/35 (85.7%). The recurrence rate of CMEC was 5.7% (2/35) and all of recurred cases were stage IV. In recurred cases, cholesteatomas were extended to sinus tympani and facial recess at revisional operation as well as initial operation. So we concluded that preoperative CT scan is essential in defining the extent of existing pathology. The intraoperative CMEC extension and location influence the outcome of surgery. In the higher stages, careful eradication of disease, particularly in the region of sinus tympani and facial recess is recommended.

Objective To investigate the effect of transforming growth factor (TGF)-β1 on the extracellular signal-regulated kinase (ERK) and Smad pathway and the role of peroxisome proliferator-activated receptor (PPAR)-γ in cultured human endometrial stromal cells. Design Experimental study. Setting Infertility center of a tertiary university hospital. Material(s) Human endometrial tissues obtained by hysterectomy from patients with conditions other than endometrial diseases. Intervention(s) Endometrial stromal cells were cultured under normal laboratory conditions. TGF-β1, rosiglitazone (PPARγ agonist), and PD98059 (ERK inhibitor) were added to endometrial stromal cell culture according to experimental purposes. Main Outcome Measure(s) Cell count, PRL expression, Smad and ERK phosphorylation, cyclooxygenase (COX)-2 expression, and prostaglandin E2 (PGE2) release. Result(s) TGF-β1 inhibited cellular proliferation and induced the expressions of COX-2, PGE2, and PRL of cultured human endometrial stromal cells. These effects may be mediated by Smad and ERK phosphorylation. Treatment with rosiglitazone, a PPARγ agonist, reversed the TGF-β1 effect by antagonizing the activation of ERK and Smad that was induced by TGF-β1. Conclusion(s) PPARγ plays a negative role by directly acting on Smad and ERK phosphorylation in human endometrial cell decidualization that is induced by TGF-β1 in vitro.

Surgical staging of endometrial carcinoma is practiced to identify the true extent of disease. The impact of para-aortic lymphadenectomy (PALD) on survival is unproven. The purpose of this study was to determine if a staging procedure that includes PALD is associated with improved survival in endometrial carcinoma patients who had been surgically staged.Retrospective review of patients' records.Ajou University Hospital, a tertiary care hospital in South Korea.One hundred and sixty patients with endometrial carcinoma.We retrospectively analyzed a total of 160 FIGO stage I-III endometrial carcinoma patients without grossly metastatic para-aortic lymph nodes, who underwent surgery between 1994 and 2007. Exclusion criteria included presurgical radiation, stage IV disease and sarcomas. Two groups were identified: patients who underwent pelvic lymphadenectomy (PLD) and PALD (n=85) versus those who underwent PLD alone (n=75). Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model.Disease-free and overall survival.Overall, patients who underwent PALD demonstrated improved 5-year disease-free survival (81.0 vs 91.2%) and overall survival (85.8 vs 96.2%) compared to those who underwent PLD alone (p=0.019 and p=0.039, respectively). After multivariate analysis, patients' age (p=0.028), FIGO stage (p0.001) and lymphadenectomy (p=0.014) were independent prognostic factors. The type of lymphadenectomy did not affect survival of low-risk patients. In intermediate to high-risk patients, PALD improved disease-free survival and showed a trend toward improvement of overall survival.These data demonstrate that PALD has a potentially therapeutic benefit on survival in surgically staged patients with intermediate to high-risk endometrial carcinoma.

The impact of micropapillary histology on survival in patients with serous borderline ovarian tumors is not established. The purpose of this study was to evaluate the significance and influence of micropapillary pattern on clinical outcome of patients with serous borderline ovarian tumors.Eighty-five patients who underwent surgery and were diagnosed with serous borderline ovarian tumors were retrospectively studied. Among these patients, 18 patients showed micropapillary pattern on histologic examination, while the remaining 67 patients did not. The significance of the presence of micropapillary pattern and relationship with various clinicopathologic findings and progression-free survival were evaluated by statistical analysis.No differences with regard to age, parity, body mass index, pretreatment CA-125 level, tumor size, bilaterality, and the duration of follow-up were observed between the two groups, but there was a significant difference in terms of FIGO stage (p0.001), invasive implants (p=0.004), performing lymphadenectomy (p=0.009), operation time (p=0.003), estimated blood loss (p0.001), residual disease1 cm (p=0.001), adjuvant chemotherapy (p0.001), and the length of hospital stay (p=0.013). Progression-free survival was found to be significantly decreased in patients with invasive implants (HR, 5.06; p=0.025) and micropapillary pattern (HR, 4.20; p=0.056) on multivariate analysis.Micropapillary serous borderline ovarian tumors were associated with a more aggressive clinical course compared with typical serous borderline ovarian tumor. The presence of invasive implants and micropapillary pattern were significant prognostic factors in patients with serous borderline ovarian tumors.

OBJECTIVES: To evaluate the clinical and biochemical characteristics of middle ear effusion (MEE) that affect distortion product otoacoustic emissions (DPOAE) responsiveness and to investigate the possible role of DPOAE as a tool to know the characteristics of MEE preoperatively.STUDY DESIGN AND SETTING: Prospective analysis of children with MEE effusion in a tertiary referral center. DPOAE results were compared with other audiologic tests, the character, amount of MEE, the amount of total protein, and TNF-α in the effusion.RESULTS: The negative DPOAE with MEE group had much more thick mucous fluid in their middle ears than that of positive DPOAE with MEE group. The levels of total protein and TNF-α in MEE were significantly higher in the negative DPOAE group than those of the positive DPOAE group (P < 0.01).CONCLUSIONS AND SIGNIFICANCE: The measurement of DPOAE in the children with MEE may predict the amount and the characteristics of MEE, which may help to decide the treatment methods.© 2007 American Ac...

The purpose of this study is to review FIGO stage IB2 cervical cancers in Korea for the past 10 years, and evaluate the most frequently employed and appropriate management strategy, and also assess the survival benefits of neoadjuvant chemotherapy (NAC). This is a retrospective chart review of 727 FIGO stage IB2 patients from 1995 to 2005. Six hundred ninety-two patients were enrolled, and all dates on which the patients died were double checked through the “National Registry of Death Statistics” of the Korea National Statistical Office. Management strategies were divided into five groups according to the primary treatment modality. The most frequently employed primary treatment modality for stage IB2 cervical cancer in Korea during the past 10 years was radical hysterectomy (RH). The next was NAC, followed by radiotherapy (RT) and/or extrafascial hysterectomy, concurrent chemoradiotherapy (CCRT) and/or extrafascial hysterectomy, in descending order. The surgery group showed the best results, with an 89% 5-year disease-free survival rate. However, there was no statistical difference between the surgery, NAC, and CCRT groups. For FIGO stage IB2 cervical cancer during the past 10 years in Korea, RH and adjuvant RT or CCRT was the most frequently employed treatment strategy. As a primary modality, RH, NAC, and CCRT showed similar survival rates. However, RH demonstrated the best survival rate among the above treatment strategies

Background Bacterial infection, Eustachian tube dysfunction, allergies, and immunologic factors are major causes of otitis media with effusion (OME). However, the exact pathogenesis of OME is still unclear. This study evaluated whether allergy influences bacterial growth in middle ear effusions. Materials Fifty-four samples were obtained from OME patients 3–10 years of age who underwent ventilation tube insertion and were divided into two groups based on the presence of allergy as determined using the multiple allergosorbent test (MAST). Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis bacterial DNA in the middle ear effusions was analyzed using polymerase chain reaction. Overall detection rates and those for each species were compared between the two groups. Results Of the 54 middle ear effusion samples, 38 (70.4 %) contained bacterial DNA and 14 (36.8 %) of these contained DNA from multiple species. S. pneumoniae was detected in 27 samples (50 %), H. influenzae in 17 samples (31.4 %), and M. catarrhalis in 9 samples (16.6 %). There was no significant difference in the bacterial detection rates between the middle ear effusions of the MAST-positive and MAST-negative groups. Conclusion The rate of bacteria detection in middle ear effusions did not differ between allergic and non-allergic children.

Ovarian cancer is one of the main gynecological malignancies including cervical cancer and endometrial cancer. Epithelial ovarian cancer generally presents with already advanced disease at the time of diagnosis and is accompanied by poor prognosis. However, stage I ovarian cancer defined as lesions confined to the ovary is usually considered to have a good prognosis, illustrated by a 5-year survival rate of greater than 70-80%. Also, recurrences tend to be late and are usually in the abdominopelvic cavity. Metastases to the skeletal structures are rare. We report a rare case of early stage IA ovarian cancer, in which the first recurrent lesion was bone metastasis.

Objective To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section. Methods Fifty-one patients with placenta previa totalis diagnosed by transvaginal sonography and with a history of Cesarean section who delivered at our hospital were included in the study. The sonographic findings of intraplacental lacunae were classified into one of four grades. Pathological analysis of the placenta was performed for all patients who delivered, and in cases of hysterectomy, examination of the uterus was also performed. The placental findings and obstetric complications, including massive transfusion, intensive care unit admission and Cesarean hysterectomy, were compared with the grade of lacuna. Results Lacunae were classified as Grade 1+ in 10 cases, Grade 2+ in 11 cases, Grade 3+ in five cases and as Grade 0 (i.e. lacunae were absent) in the remaining 25 cases. When lacunae of ≥ Grade 1+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing adherent placenta were 86.9%, 78.6%, 76.9% and 88.0%, respectively. When lacunae of ≥ Grade 2+ were considered, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing placenta increta or percreta were 100%, 97.2%, 93.8% and 100%, respectively. Hysterectomy was performed in 18 cases, among whom two cases showed Grade 1+ lacunae, 11 cases showed Grade 2+ lacunae, and five cases showed Grade 3+ lacunae. No hysterectomy was performed in any case in which lacunae were absent. Compared to those without lacunae, the number of massive transfusions and intensive care unit admissions and cases of disseminated intravascular coagulopathy and Cesarean hysterectomy were significantly greater in those with lacunae (P < 0.0001). Conclusion Transvaginal sonographic findings of intraplacental lacunae in patients with placenta previa totalis and a history of Cesarean section are useful in the prediction of adherent placenta and may have a role in the prediction of clinical outcome. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.

A novel inhibitor of apoptosis, Survivin, seems to be involved in the critical steps of cancer onset and progression and may be associated with unfavorable clinical outcome. We investigated the expression of Survivin in patients with cervical intraepithelial neoplasia grade 3 (CIN3) and uterine cervical cancer, to determine whether Survivin expression is related to poor prognosis. Fourteen cases of CIN3, 53 cases of invasive uterine cervical squamous cell carcinoma (SCC), and 11 cases of normal control group were analyzed retrospectively. Immunohistochemical staining and Western blot was performed with antihuman Survivin antibody and analyzed with respect to patient outcome. Survivin was significantly expressed in cervical cancer groups compared to the normal control group (P0.05). Significant Survivin expression was also noted in cancer patients with lesion sizeor =4 cm, lymphovascular invasion, elevated SCC antigen levels, and no response to initial therapy. In more advanced stages, Survivin expression tended to increase but without statistical significance (P = 0.081). No association was noted between Survivin expression and survival rate (P = 0.1011). We conclude that Survivin expression provides some prognostic information regarding uterine cervical cancer, even though it was not correlated with survival. It could represent a possible new prognostic marker of uterine cervical SCC patients.

Microsatellite instability and loss of heterozygosity has been implicated in ovarian carcinogenesis. The reported frequency of microsatellite instability in human ovarian cancer varies significantly owing to the use of heterogeneous tumor histotypes and various microsatellite markers in different laboratories. In this study, we determined the frequency of microsatellite instability in 74 ovarian endometrioid carcinomas using four microsatellite markers (BAT25, BAT26, D5S346, D17S250), and examined hMLH1 and hMSH2 protein expression. In all, 20% of the tumors were microsatellite instability high (two or more markers showing instability) and 12% were microsatellite instability low (one marker showed instability). Loss of hMLH1 and/or hMSH2 expression was found in nine of 15 microsatellite instability-high tumors. The microsatellite instability-high phenotype tended to occur more frequently in low-grade tumors (P=0.053), but did not correlate with clinical stage. Totally, 38% of cases also displayed loss of heterozygosity at D17S250; this loss of heterozygosity was associated with high clinical stage (P=0.097). Our results indicate that both microsatellite and loss of heterozygosity at D17S250 are involved in the development of ovarian endometrioid carcinoma.

Objectives. In this study, we have established an in vitro three- dimensional (3D) coculture, where normal endometrial stromal cells and endometrial cancer cells were cocultured under defined hormonal conditions, to investigate the potential paracrine effects on synthesis and secretion of matrix metalloproteinases (MMPs) and, thus, cancer invasion. Methods. Endometrial stromal cells were obtained by biopsy, cultured in the presence of 100 nM estrogen for 3 days, and then mixed with extracellular matrix (ECM) composed of collagen I and matrigel in a 4:1 ratio. After 3 more days in culture, a 3D coculture was established with HEC-1A cells, an endometrial adenocarcinoma cell line, grown on top of the mixture under various ovarian steroids (no steroid, 100 nM b-estradiol (E2), or 1.0 mM progesterone (P4)) for 10 days. The expression and local- ization of MMP-2, MMP-9, and integrin b3 subunit were visual- ized by immunocytochemistry and analyzed by reverse transcrip- tion polymerase chain reaction (RT-PCR). The extent of cancer invasion was quantified by Boyden's chamber assay. Results. Integrin b3 subunit was localized along the cell surface of HEC-1A cell under all three hormonal conditions. MMP-2 was located in the cytoplasm of stromal cells and on the surface of HEC-1A cells. Synthesis and secretion of stromal MMP-2 were increased in the presence of ovarian steroids. In contrast, expres- sion of stromal MMP-9 was suppressed in the presence of ovarian steroids. No MMPs were synthesized in HEC-1A cells. Invasion assay revealed that HEC-1A cells achieved high tumoral invasive- ness in the presence of b-estradiol. Conclusions. These findings suggest that stromal cell-derived MMP-2 is translocated to the surface of HEC-1A cells. Integrin b3 subunit might contribute, in part, to providing a binding site for MMP-2. Thus, HEC-1A cells invade by recruiting MMP-2 secreted by stromal cells, which is greatly enhanced in the presence of b-estradiol. The 3D coculture provides an excellent experimental system in which single parameters can be isolated from a complex in vivo system in the process of endometrial cancer invasion. © 2001 Academic Press

Objective. The enzymes cyclooxygenase (COX)-1 and -2 are necessary for the synthesis of prostaglandins. COX-2 is usually absent in normal cells and is upregulated and expressed as a product of the "immediate early" gene during inflammatory processes. In previous studies, the expression of COX-2 has been shown to be induced by proinflammatory cytokines, and suggestions have been made that overexpression of COX-2 suppresses apoptosis and is directly related to tumor growth. We have attempted to determine a relationship between tumor invasion and metastasis of uterine cervical cancer and COX and apoptosis by comparing the protein expression of apoptosis, COX-1, and COX-2 in tumor tissues. Methods. The subjects were 36 patients who were FIGO stage IB uterine cervical cancer patients who underwent surgery at Ajou University Hospital. There were 12 cases with lymph node or parametrial involvement. All tissues were subjected to immunohistochemical staining for COX-1, -2, and TUNEL method for apoptosis detection, and the following results were obtained. Results. Tumor tissues confirmed by cytokeratin were separated into tumor surface, tumor stroma, and invasion site portions, in which decreased apoptosis was observed in the invasion sites. COX-2 expression was observed in all tumor tissues and was especially strong in the tumor invasion site. Therefore, it is suggested that COX-2 expression may suppress cell apoptosis at the tumor invasion site. When COX-2 expression was investigated according to the groups with regard to the presence of lymph node or parametrial involvement, there was a statistically significant (Mann–Whitney U test) COX-2 expression difference in the tumor invasion site ( P value=0.040) and the tumor stroma ( P value=0.028). Conclusions. In surgically treated stage IB cervical cancer patients, COX-2 was significantly expressed when lymph node or parametrial involvement was present. These results suggest that the expression of COX-2 in stage IB cervical cancer may downregulate apoptosic processes and thus enhance tumor invasion and metastasis.

Study Objective . To ascertain if color Doppler sonography (CDS) can detect viability of adnexa in torsion. Design. Concurrent, nonrandomized study (Canadian Task Force classification II-2). Setting. Tertiary medical care center in a university hospital. Patients. Twenty-seven women suspected of having torsion of the ovary in which a benign tumor was present. Interventions. Color Doppler sonography of the ovarian pedicle suggested torsion. Laparoscopy or laparotomy was performed in 19 patients and confirmed the diagnosis. Measurements and Main Results. We identifed a twisted vascular pedicle of the ovarian tumor by CDS in 24 (88%) of 27 women. Pedicle arterial and venous blood flow was observed in 10 women; pathology specimens revealed normal tissue, edema with congestion, or early hemorrhage. In all nine in whom only arterial blood flow or no blood flow was observed, pathology revealed hemorrhagic necrosis. In five women with arterial and venous blood flow the tumor was managed conservatively, either by detorsion or cystectomy, after which no embolism or tumor recurrence was seen at follow-up ultrasonography. Normal follicular development and ovulation occurred in these patients. Conclusion. For women of childbearing age in whom torsion of benign adnexal tumors is suspected, CDS should be performed to confirm the diagnosis and ascertain whether or not pedicle arterial and venous blood flow is present. If such blood flow is detected, the adnexa is considered to be viable and detorsion or cystectomy may be performed, thus preserving the ovary. It is recommended that further studies with a larger group be undertaken to provide a basis for statistical analysis.

In this study, we evaluated the surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation (CI). Twenty computed tomography (CT) images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. Three-dimensional (3D) reconstructed images were obtained using high-resolution axial temporal bone CT scans. Eight points were used to evaluate the surgical anatomy of the posterior tympanotomy and cochleostomy. The length of lines between the points and the angles between the lines were measured. The mean length of line AB (superior-inferior length of the posterior tympanotomy for CI) was 6.48 ± 0.26 mm, while line AC (width of the chorda tympani and facial nerves) was 3.60 ± 0.2 mm. The mean angle of ABC (angle at which the chorda tympani nerve branched from the facial nerve) was 18.40° ± 1.05°. The mean length of line AD (distance from the facial ridge to the point of cochleostomy) was 9.58 ± 0.47 mm. 3D imaging of the facial recess and round window can be used to identify the facial recess before surgery. This may help to avoid injury to the chorda tympani nerve during posterior tympanotomy, and make it easier to insert the electrode array during CI by creating a large enough posterior tympanotomy to avoid injury to the facial nerve, which can cause immediate or delayed facial palsy.

Intralabyrinthine schwannomas are benign tumors arising de novo from the perineural Schwann cell sheath of the intralabyrinthine branches of the vestibulocochlear nerve. The development of magnetic resonance imaging (MRI) has significantly increased the diagnosis of these tumors. Intralabyrinthine schwannomas can be sub-classified into seven groups according to the structures of the inner ear that are affected. The management strategy for intralabyrinthine schwannoma is regular monitoring with MRI, as the tumor grows slowly. In cases where the tumor growth is documented on serial MRI or disturbing vestibular symptoms are present, surgical removal can be considered. The surgical approach varies based on tumor location and size. We report a case of intravestibulocochlear schwannoma causing vertigo that developed from an intracochlear tumor during MRI. We successfully removed the tumor via the transotic approach.

To find out whether a negative finding on magnetic resonance imaging (MRI) can rule out bladder or rectum mucosal invasion safely without cystoscopy or sigmoidoscopy.We retrospectively reviewed the medical records of patients with cervical cancer between January 2005 and December 2009. MRI findings on bladder or rectum were classified as follows: (1) definite evidence of mucosal invasion, (2) suggestive of mucosal invasion or (3) no evidence of mucosal invasion. We correlated MRI findings with the cystoscopy and sigmoidoscopy findings.A total of 257 patients were enrolled in this study. Sixteen patients had at least suspicious bladder invasion, and 1 patient had definite rectal invasion on MRI. Of these 17 patients, 6 patients had actual bladder mucosa invasion, and 1 patient had rectal mucosa invasion. The remaining 240 had negative MRI, cystoscopy and sigmoidoscopy findings. The MRI sensitivity, specificity, positive predictive value, negative predictive value and accuracy of bladder or rectum mucosal invasion were 100%, 96.0%, 41.25%, 100% and 96.1%, respectively.Skipping cystoscopy or sigmoidoscopy based on the absence of invasion on MRI is safe enough without concern for understaging.

A petrified auricle is a rare condition in which the structure becomes partially or completely rigid. It arises as a consequence of calcification or ossification of the auricular cartilage. An ossified auricle is much more rare than a calcified cartilage, and it can be diagnosed only by histology. To the best of our knowledge, only 18 cases of ossification of the auricle have been previously reported in the literature. We report a new case of auricular ossification in a 72-year-old woman who had taken calcium for the previous 8 years. We also review the relevant literature.

Aim: To investigate the survival of patients with intermediate-risk endometrial cancer treated with comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy and adjuvant vaginal brachytherapy (VBT). Methods: Between January 2000 and December 2009, we retrospectively reviewed the medical records of 156 patients who underwent comprehensive surgical staging consisting of total hysterectomy, adnexectomy, peritoneal cytology, and complete pelvic/para-aortic lymphadenectomy. There were 122 low-risk and 34 intermediate-risk patients, and intermediate-risk patients received adjuvant VBT. Results: During the follow-up period, 7 (4.5%) of the 156 patients developed recurrent disease: 3 (2.5%) of the 122 low-risk and 4 (11.8%) of the 34 intermediate-risk patients. Among the 7 patients with recurrent disease, only 1 intermediate-risk patient died of disease and 6 stayed alive for the rest of the follow-up period. Disease-free survival at 5 years was 95.7% in the low-risk patients and 81.6% in the intermediate-risk patients, and this difference was statistically significant (p = 0.009). There was no statistically significant difference in overall survival at 5 years between the two groups (100% in low-risk patients vs. 96.7% in intermediate-risk patients, p = 0.061). Overall, grade 3 toxicities were seen in 1 (2.9%) patient. Conclusion: Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant VBT improves survival rates for intermediate-risk endometrial cancer patients, which are comparable with those of low-risk patients.

Sarcomatoid squamous cell carcinoma of the uterine cervix is a rare tumor with uncertain pathogenesis. The rarity of this neoplasm makes it difficult to diagnose and manage, and it seems to be an aggressive tumor with a short disease-free survival. To date,20 cases have been reported. We report the first case of sarcomatoid carcinoma successfully treated by laparoscopic radical hysterectomy.A 26-year-old woman presented with postcoital spotting. Gynecologic examination revealed an approximately 2.5-cm-diameter mass on the posterior lip of the cervix, and biopsy revealed a sarcomatoid carcinoma. After the baseline study for cervical cancer, the patient was found to have International Federation of Obstetricians and Gynecologists stage IB1 disease. The patient underwent laparoscopic radical hysterectomy with bilateral pelvic and paraaortic lymphadenectomy. Histopathologic examination showed no evidence of parametrial tumor extension or lymph node metastasis, and no adjuvant treatment was given.This report entails the first description of laparoscopic surgery for sarcomatoid carcinoma of the cervix. Despite short-term follow-up, it seems that early-stage disease could be successfully treated by laparoscopic radical hysterectomy.

The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P.001), tumor size (P = .003), depth of myometrial invasion (P.001), cervical invasion (P.001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P.001), serosal/adnexal invasion (P.001), positive cytology (P = .002), peritoneal seeding (P.001), and pelvic LNM (P.001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.

As congenital middle ear cholesteatoma (CMC) is a different disease entity from acquired cholesteatoma, early diagnosis is important for good treatment results. Preoperative computed tomography (CT) imaging is a useful modality for both evaluation of the extent of the disease and selection of appropriate surgical methods. Some modification should be considered based on the findings of the actual operative field for complete removal of CMC.To present the results of surgical treatment of 71 cases of CMC and investigate the applicability of preoperative CT for the treatment of CMC.A retrospective study over an 11-year period was performed. The presenting symptoms, tympanic membrane findings, surgical findings, methods, and results were investigated retrospectively.CMC was found incidentally in 38 cases (53.5%). A whitish mass medial to the tympanic membrane was observed in 62 cases (87%). Postoperative air-bone gap changes were not statistically significant. There was no predominance of localized lesions of the middle ear. The recurrence rate was 9.9% (seven cases), and higher in open type. Staging by CT and surgical staging matched in 70.4%. Positive predictive value for mastoid involvement of CT staging was 72.7%, with sensitivity and specificity of 68.6% and 87.5%, respectively.

Examination of 631 infertile women, including 434 women with endometriosis and 197 without endometriosis, revealed an increasing incidence of endometrial polyps, especially in the test subjects with endometriosis, and advanced stages of endometriosis. Expression of Ki-67 and Bcl-2 proteins and MTT assay results were significantly higher in endometrium of patients with endometriosis than in patients without endometriosis. These showed increased proliferation activity and cell proliferation markers not only clinically but also pathologically.

Ovarian dysgerminoma is usually hormonally inert, but when it contains syncytiotrophoblastic giant cells or undergoes malignant transformation, the level of estradiol might be elevated. A 6-year-old girl contracted ovarian dysgerminoma with precocious puberty, and her levels of beta-human chorionic gondaotropin, alpha-fetoprotein and estradiol were high. After resection of the tumor, levels of tumor markers became normal and precocious puberty disappeared. We report this unusual type of dysgerminoma with a brief review of the literature.

Postoperative ventilation tube (VT) blockage is relatively common with a reported incidence of 0.0-13.1%. The purpose of this study was to evaluate the factors that contribute to postoperative VT blockage. A retrospective chart review was carried out to compare rates of VT blockage within 2 weeks postsurgery. Analyzed factors included: otic drop, nature, and amount of middle ear (ME) effusion, presence of ME mucosa edema or granulation, bleeding during surgery, number of prior VT insertion, and the status of the tympanic membrane (TM). One hundred and twenty-eight ears from 79 patients were enrolled in this study. Eleven VTs (8.6%) were obstructed within 2 weeks postsurgery. Ears using ciprobay and tarivid otic drops showed a significantly higher rate of tube blockage (14.1%) compared to ears that were not exposed to otic drops (1.8%). Glue effusion caused the highest rates (14.8%) of tube blockage compared to mucoid (9.6%) and serous (3.0%) effusions. The amount of effusion, the presence of mucosal edema or granulation, bleeding during surgery, number of prior VT insertions and the status of the TM were not associated with postoperative VT blockage. The results of this study suggest that the routine use of antibiotic-containing otic drops after the insertion of VT may not be useful. Viscosity of the effusion appears to have an effect on the postoperative VT blockage. Thus, more attention should be focused on the ears with glue or mucoid effusions after surgery.

Purpose The objective of this study was to summarize clinical presentation, treatment, and recurrence of preauricular sinuses. Materials and methods This retrospective, institutional review board-approved study reviewed the medical records of patients who underwent preauricular fistulectomy between January 1995 and June 2005 at university-based hospitals in South Korea. Only patients who underwent classic preauricular fistulectomy (not incision and drainage) and could be followed up for at least 3 months were included in the study. Results A total of 191 patients (206 ears) were enrolled. The right and left ears were involved in 79 and 97 patients, respectively. The most common location of the preauricular pit was the anterior margin of the ascending limb of the helix (93.2%). The most common indication for surgery was the recurrent exacerbation of acute infection (58.3%). The recurrence rate after surgery was 4.9%. Surgery under local anesthesia contributed to recurrence after the procedure (P = .009) and the cases that featured local infiltrative anesthesia had a higher rate of recurrence than the cases that had general anesthesia with an odds ratio of 6.875. Conclusions Although this study showed that surgery under local anesthesia contributed to recurrence, it did not mean that it was only the anesthesia technique that influenced the recurrence. Surgeons should bear in mind that complete removal of the epithelial lining provides a lower recurrence rate, especially under local anesthesia. The main limitation of this study was that recurrent cases were too few to allow a statistical analysis.

Objective This study evaluated the prognostic factors in Bell's palsy and Ramsay Hunt syndrome (HZO). Methods A retrospective, institutional review board-approved study at a university-based hospital. A total of 81 patients consisting of 55 Bell's palsy patients and 26 HZO patients were enrolled in this study. The treatment consisted uniformly in all cases, and acyclovir was administered in the case of Ramsay Hunt syndrome. All patients were followed up until they recovered or for least up 6 months. Results The recovery rates to House-Brackmann grade II or better were 96.3% in those with Bell's palsy and 84.6% in those with HZO. In the HZO cases, older patients had a poorer initial and final status, and less chance of making a complete recovery than the younger patients. The HZO patients without diabetes mellitus had a higher chance of recovery, a higher chance of complete recovery, and a better final status. In addition, HZO patients without essential hypertension had a higher degree of recovery. HZO patients not suffering from vertigo had a higher chance of recovery. Conclusion There was no prognostic factor found in the Bell's palsy patients in this study. The prognostic factors of HZO were age, diabetus mellitus, essential hypertension and vertigo.

Amniotic fluid embolism is a life-threatening complication of pregnancy accompanied by a high mortality rate. The common clinical presentation is sudden onset of dyspnea, hypotension inappropriate to the volume of blood loss, and hypoxia, followed by cardiopulmonary arrest. Recently, cases of amniotic fluid embolism with isolated coagulopathy as an atypical presentation have been reported.A 27-year-old multigravida presented with continuous postpartum oozing after an uneventful vaginal delivery at 38 weeks of gestation. Laboratory evidence revealed disseminated intravascular coagulopathy. Despite good uterine contractions and massive blood component therapy, vaginal bleeding continued and finally led to emergency laparotomy. Histopathologic examination showed a deep cervical laceration in the endocervix, and multiple areas of amniotic fluid debris were demonstrated in the laceration site vasculature of the endocervix. After hysterectomy, the patient recovered fully, without sequelae.This case represents atypical symptoms and signs: clinical hemorrhage in the initial presentation rather than the classical pattern of cardiopulmonary collapse. In cases of suspected amniotic fluid embolism with an atypical presentation, a thorough histologic examination of the uterus, including the cervix, is critical to making the diagnosis of amniotic fluid embolism.

Intrauterine intussusception, an uncommon cause of bowel obstruction, has rarely been detected by prenatal ultrasonography. We report two cases of intrauterine intussusception after gestation, which presented as isolated fetal ascites at 30 weeks of gestation by ultrasonography. In case 1, on the follow-up ultrasonography at 32 weeks of gestation, the previously observed ascites had disappeared, whereas the echogenicity of the bowel was increased without any sign of dilation, suggesting the presence of meconium peritonitis. The fetus was delivered at 39 weeks. In case 2, however, the amount of fetal ascites became increased, and the fetus was delivered at 34 weeks of gestation. After delivery, both infants were surgically explored with resection of the ileum with end-to-end anastomosis because of intrauterine intussusception and ileal atresia. From the experience of these cases, we suggest that the ultrasonographic finding of isolated or transient fetal ascites might contribute to the early diagnosis and management of intrauterine intussusception.

Objective This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high-risk early cervical cancer (stages IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. Methods From July 1994 to June 2001, we retrospectively reviewed the medical records of 151 patients who had undergone radical abdominal hysterectomy with pelvic lymphadenectomy and paraaortic lymph nodes dissection at Ajou University Hospital for early cervical cancer (stages IA2, IB, IIA). CCRT was performed in 30 patients with high-risk factors such as positive pelvic lymph nodes, parametrial involvement, or positive surgical margins. Adjuvant chemotherapy consisted of cisplatin (70 mg/m 2 on day 1) and 5-fluorouracil (5-FU; 1000 mg/m 2 on days 2–5) for four cycles every 4 weeks beginning 2–3 weeks after surgery. Pelvic radiotherapy was started concurrently at the second and third cycle of chemotherapy. We also analyzed the recurrence pattern and survival rates of 114 patients (control group) who received no adjuvant therapy after surgery. The mean follow-up period was 49 months (24–98 months). Results There were recurrences in three patients after CCRT (10%) and in five patients in the control group (4.4%). The actuarial 5-year overall survival rates for patients in CCRT and control group were 96.7% vs. 97.7%, respectively. The progression-free survival rates were 88.7% for the high-risk group and 95.4% for the non-high-risk group. Conclusions This study confirms good local control and 5-year overall and progression-free survival rates in high-risk cervical cancer patients after CCRT, which is comparable with the results of the control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stages IA2–IIA cervical cancer patients with high-risk factors.

The purpose of this study was to determine whether mutations in the Bax gene play a role in the development of ovarian endometrioid carcinoma with a microsatellite instability phenotype. We analyzed a total of 60 tumor specimens, 49 ovarian endometrioid carcinomas and 11 concurrent endometrial endometrioid carcinomas from 49 patients. Fourteen ovarian endometrioid carcinomas and 6 endometrial endometrioid carcinomas showed a microsatellite instability-high phenotype. Tumor and normal-tissue specimens from eight patients with a microsatellite instability-high phenotype colorectal carcinoma were included in this study as controls. The presence or absence of a mutation in the poly (G) 8 tract of the Bax gene was determined by polymerase chain reaction followed by direct DNA sequence analysis. A 1-base pair deletion at the poly (G) 8 tract and no expression of Bax and Bcl-2 proteins were identified in one microsatellite instability-high endometrial endometrioid carcinoma. Immunohistochemical staining for Bax and Bcl-2 proteins was negative on the tumor specimen that had this 1-base pair deletion. No mutations were found in the synchronous microsatellite instability-high ovarian endometrioid carcinoma from the same patient. In contrast, four (50%) of the eight microsatellite instability-high sporadic colorectal carcinomas had a mutation in the poly (G) 8 tract. Although Bax plays an important role in carcinogenesis of the colorectum with microsatellite instability-high phenotype, Bax may not play a direct role in the genesis of ovarian endometrioid carcinoma, regardless of microsatellite instability status.

Matrix metalloproteinase (MMP)-2 and -9 are secreted and translocated from endometrial stromal cells to HEC-1 A cells in a steroid-dependent manner. We investigated the paracrine effect of hepatocyte growth factor (HGF) on MMPs and metalloproteinase tissue inhibitor (TIMP) expression in stromal and endometrial cancer cells, and correlated with cancer cell invasiveness in three-dimensional (3D) coculture. The 3D coculture of endometrial stromal and cancer cell lines (HEC-1 A, HEC-IB, or KLE) were maintained in the presence or absence of HGF. The expression of MMP-2 and -9, MT1-MMP, TIMP-1 and -2 were examined by RT-PCR and zymography. Under the same conditions, invasion of the cancer cells was quantified by Boyden's chamber assay. HGF strongly induced MMP-9 mRNA expression in stromal cells, but had little effect on MMP-2 mRNA. MT1-MMP mRNA was detected only in KLE and stromal cells, which was also increased by HGF. TIMP-1 and -2 mRNAs was ubiquitous with no dependence on HGF. Zymographic analysis of MMPs showed that activation of MMP-2 and -9 was enhanced by HGF. A significant increase in invasion of all three cancer cells with HGF was observed. The effect of HGF on the invasiveness of 3D cocultured endometrial cancer cells and stromal cells appears to be due to induction of MMP-9 mRNA expression in stromal cells and /or increased activation of MMP-2 and MMP-9 by proteolytic digestion.

The clinical staging system for cervical carcinoma presently recommended by the International Federation of Gynecology and Obstetrics (FIGO) does not include MRI or CT findings and thus suffers limited accuracy. Recently however, the positive contributions of MRI and CT to preoperative staging have been reported. This study involves a determination of the value of routine cystoscopy and intravenous urography, in the detection of bladder invasion or hydronephrosis resulting from cervical carcinoma, among patients who had undergone MRI or CT. Among a total 296 patients with cervical carcinoma, 271 patients (92%) had undergone MRI and 25 (8%) CT. Bladder invasion was identified pathologically by cystoscopic biopsy in 8 (57%) of the 14 patients with suspected bladder invasion on MRI or CT. There was no bladder invasion in any of the other cases lacking in bladder invasion evidence on MRI or CT. Hydronephrosis was identified by intravenous urography in 18 patients, as it also was in all of these cases on MRI or CT, confirming a negative predictive value for MRI or CT, in detecting bladder invasion or hydronephrosis from cervical carcinoma, of 100%. Therefore, although MRI or CT cannot totally replace cystoscopy, the latter is unnecessary in the absence of bladder invasion evidence on MRI or CT. Intravenous urography, however, can be safely omitted whenever MRI or CT is performed.

Purpose: Congenital middle ear cholesteatoma (CMEC) is less common than the acquired variety. Many theories have been put forward to explain the pathophysiology of CMEC; however, none of them have been convincingly proven thus far. This clinical study was performed to analyze the case reviews; assess the characteristic features of CMEC, and evaluate the correlation between those features and the pathophysiology of CMEC. Methods: The medical records of patients who underwent otologic procedures at the hospitals of the Catholic University, Seoul, Korea, from January 1993 to November 1998 have been reviewed. Results: Of the 14 patients, 3 had cystic lesions isolated to the anterosuperior quadrant of the mesotympanum. The lesions were easy to remove and did not affect the patients' hearing. Eleven patients had more extensive disease with posterior mesotympanum involvement; the lesions were large, were often too extensive to indicate a formative site, and caused ossicular damage. Conclusion: CMEC manifests in 2 distinctive forms according to the formation site. This distinctive formation site suggests that the pathophysiology of posterior lesions may be different from that of anterior ones. For early diagnosis of CMEC, a screening program should be established for children to prevent more extensive disease. (Am J Otolaryngol 2001;22:184-189. Copyright © 2001 by W.B. Saunders Company)