• Title, Summary, Keyword: vaginal involvement

Search Result 14, Processing Time 0.079 seconds

Predicting Factors for Positive Vaginal Surgical Margin Following Radical Hysterectomy for Stage IB1 Carcinoma of the Cervix

  • Sethasathien, Sethawat;Charoenkwan, Kittipat;Settakorn, Jongkolnee;Srisomboon, Jatupol
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.15 no.5
    • /
    • pp.2211-2215
    • /
    • 2014
  • Background: To examine the incidence of positive vaginal surgical margins and determine the predicting factors following radical hysterectomy for stage IB1 carcinoma of the cervix. Materials and Methods: The clinical and histological data of 656 FIGO stage IB1 cervical cancer patients who had radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2012 were retrospectively reviewed and were analyzed for their association with a positive vaginal surgical margin. A p-value of < 0.05 was considered significant. Results: Thirty-five patients (5.3%) had positive vaginal surgical margins following RHPL; 24 (3.7%) for intraepithelial lesions and 11 (1.7%) for carcinoma. On multivariate analysis, microscopic vaginal involvement by high-grade squamous intraepithelial lesion and/or carcinoma (adjusted odd ratio (OR) 186.8; 95% confidence interval (CI) 48.5-718.5) and squamous histology (OR 8.7; 95% CI 1.7-44.0), were significantly associated with positive vaginal surgical margin. Conclusions: Microscopic vaginal involvement by HSIL and/or carcinoma are strong predictors for positive vaginal surgical margins for stage IB1 cervical cancer patients undergoing radical hysterectomy. Preoperative 'mapping' colposcopy or other strategies should be considered to ensure optimal vaginal resection.

Adjuvant Radiotherapy Following Radical Hysterectomy and Bilateral Pelvic Lymph Node Dissection for the Uterine Cervical Cancer : Prognostic Factors and Failure Patterns (근칙적 절제술과 술후 방사선치료를 시행한 자궁경부암 환자의 치료성적, 예루인자와 실패양상)

  • Choi, Doo-Ho
    • Radiation Oncology Journal
    • /
    • v.15 no.4
    • /
    • pp.357-367
    • /
    • 1997
  • Purpose : To identify variable prognostic factors and analyse failure patterns in the uterine cervix cancer after radical operation and adjuvant radio-therapy, a retrospective analysis was undertaken. Materals and Methods : I analysed one hundred and twenty four patients with uterine cervix cancer, FIGO stage IB, IIA and IIB, treated with radical hysterectomy and pelvic lymph node dissection followed by adjuvant radio-therapy between May 1985 and May 1994. Minimum follow up period was 24 months. All of them were treated with full dose external radiotherapy with linear accelerator and/or high dese rate intracavitary radiation. Results : Overall 5 year survival rate and relapse free survival rate were $75.4\%,\;73.5\%$, respectively. Significant prognostic factors by relapse free survival were wall involvement thickness, lymph node location and number, parametrium involvement, tumor size, stage, uterine body involvement, vaginal resection margin involvement. By multivariate analysis, lymph node matastasis. tumor size and vaginal resection margin involvement were significant prognostic factos. Treatment related failure were 33 cases. Locoregional failure were more likely in the stage IIB, lymph node positive or vaginal resection margin positive patients whereas distant failures were relatively more frequent in stage IB, IIA and lymph node, vaginal resection negative patients. In stage IIB, 5 year relapse free survival rate was only $56\%$ and nine of twenty two patients recurred. Conculsion : Postoperative radiotherapy results are good for patients with relatively low risk factor. But the results are poor for patients with multiple, high risk factors or stage IIB. To control recurrence for patients with high risk factors, postoperative adjuvant radiotherapy is not sufficient treatment method. To raise control rate adding other methods such as radiosensitizing agent or chemotherapy is necessary and prospectively randomized study is needed for evaluation of postoperative radiotherapy efficacy and /or other methods. And it is reasonable to treat primary radical radiotherapy for patients with stage IIB cervical cancer instead of radical operation and adjuvant radiotherapy and/or chemotherapy regimen.

  • PDF

Pelvic Hydatidosis Mimicking a Malignant Multicystic Ovarian Tumor

  • Singh, Prem;Mushtaq, Deeba;Verma, Neetu;Mahajan, N.C.
    • The Korean Journal of Parasitology
    • /
    • v.48 no.3
    • /
    • pp.263-265
    • /
    • 2010
  • Echinococcosis is a multisystem disease and has propensity to involve any organ, an unusual anatomical site, and can mimic any disease process. Primary peritoneal echinococcosis is known to occur secondary to hepatic involvement but occasional cases of primary peritoneal hydatid disease including pelvic involvement have also been reported. We report here 1 such case of primary pelvic hydatidosis mimicking a malignant multicystic ovarian tumor where there was no evidence of involvement of the liver or spleen. Our patient, a 27-year-old female, was detected to have a large right cystic adnexal mass on per vaginal examination which was confirmed by ultrasonography. Her biochemical parameters were normal and CA-125 levels, though mildly raised, were below the cut off point. She underwent surgery and on exploratory laparotomy, another cystic mass was found attached to the mesentery of the small gut. The resected cysts were processed histopathologically. On cut sections both large cysts revealed numerous daughter cysts. Microscopic examination of fluid from the cysts revealed free scolices with hooklets and the cyst wall had a typical laminated membrane with inner germinal layer containing degenerated protoplasmic mass. The diagnosis of pelvic hydatid disease was confirmed and patient was managed accordingly. Hydatid disease must be considered while making the differential diagnosis of pelvic cystic masses, especially in endemic areas.

Postoperative Adiuvant Radiation Therapy in Endometrial Carcinoma (자궁내막암의 수술 후 보조적 방사선치료)

  • Shin Kyung Hwan;Choi Eun Kyung;Ahn Seung Do;Chang Hyesook;Mok Jung-Eun;Nam Joo Hyun;Kim Young Tak;Kim Yong Man;Kim Jong Hyeok
    • Radiation Oncology Journal
    • /
    • v.18 no.1
    • /
    • pp.40-45
    • /
    • 2000
  • Purpose : To evaluate the histopathological prognostic factors, relapse pattern and survival in patients with endometrial carcinoma who were treated with surgery and postoperative adjuvant radiotherapy (RT). Methods and Materials : From September 1991 to December 1997, 27 patients with endometrial carcinoma treated with surgery and postoperative adjuvant RT at Asan Medical Center were entered in this study. Surgery was peformed with total abdominal hysterectomy in six, total abdominal hysterectomy with pelvic lymph node dissection in eight and radical hysterectomy in 13 patients. External RT of 50.4 Gy was done to all patients and among these, additional high dose rate vaginal vault irradiation of 20$\~$25 Gy with fractional dose of 4$\~$5 Gy was boosted In 16 patients. The patients were followed for 6$\~$95 months(median 30). Results : The number of patients according to FIGO stage were I 18 (67$\%$), II 1 ($4\%$) and III 7 ($26\%$). Patients with poor histologic grade, deep myometrial invasion, adnexal involvement, lymphovascular invasion showed more pelvic lymph node involvement, but no statistical significance was indicated. The 5 year overall and disease free survival were 100$\%$ and 76.8$\%$, respectively. Relapse sites were pelvic, para-aortic lymph node, and multiple metastases including lung, and no vaginal relapse was developed. Factors that were associated with disease free survival were FIGO stage (p=0.01), lymphovascular invasion (p=0.03), pelvic lymph node involvement (p=0.0001). There was only one Grade 1 rectal bleeding without moderate to severe complications. Conclusion : Postoperative adjuvant RT is considered to reduce the loco-regional failure, resulting the improvement of survival. The group of patients with the risk of vaginal failure without vaginal vault irradiation should be investigated according to stage and grade.

  • PDF

Improved Cell Viability and Anti-Candida Activity of Probiotic Lactobacillus salivarius MG242 by Heat Adaptation (Lactobacillus salivarius MG242의 열 전처리시 생존율 증진 및 항 캔디다 효과)

  • Kang, Chang-Ho;Kim, YongGyeong;Shin, YuJin;Paek, Nam-Soo;So, Jae-Seong
    • Journal of Dairy Science and Biotechnology
    • /
    • v.37 no.1
    • /
    • pp.49-56
    • /
    • 2019
  • Vulvovaginal candidiasis is a major urogenital infection in women. Lactobacilli are important in maintaining vaginal health. In the present study, the effect of heat adaptation at $47{\sim}52^{\circ}C$ prior to heat stress at $60^{\circ}C$ in improving the viability of Lactobacillus salivarius MG242 was examined. L. salivarius MG242 has antifungal effects against Candida albicans. Heat-adapted cells had a higher survival rate than non-adapted cells during the subsequent heat stress. When chloramphenicol was added during the adaptation process, heat tolerance was abolished, suggesting the involvement of de novo protein synthesis with the heat adaptation of L. salivarius MG242 strain. Exopolysaccharide quantification and scanning election microscopy did not reveal any appreciable changes during heat adaptation. The antifungal activity of L. salivarius MG242 against C. albicans was maintained during the heat adaptation. These results suggest that heat adaptation can be applied for the development of probiotic products using L. salivarius MG242 to improve its stress tolerance during processing.

Decision-making process and satisfaction of pregnant women for delivery method (임산부의 분만방법 결정과정과 만족도)

  • Jun, Hae-Ri;Park, Jung-Han;Park, Soon-Woo;Huh, Chang-Kyu;Hwang, Soon-Gu
    • Journal of Preventive Medicine and Public Health
    • /
    • v.31 no.4
    • /
    • pp.751-769
    • /
    • 1998
  • This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband (0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand (12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9% . However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.

  • PDF

Surgical Outcomes of Patients with Stage IA2 Cervical Cancer Treated with Radical Hysterectomy

  • Mahawerawat, Sukanda;Charoenkwan, Kittipat;Srisomboon, Jatupol;Khunamornpong, Surapan;Suprasert, Prapaporn;Sae-Teng, Charuwan Tantipalakorn
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.14 no.9
    • /
    • pp.5375-5378
    • /
    • 2013
  • Background: This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomy or radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors (nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at least cervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identify factors associated with median survival. At the median follow up time of 73 months, the 5-year disease-free survival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelvic lymph node metastases. In a univariate analysis, there was no statistically significant association between survival and prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin status and lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent. No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treated with simple or less radical hysterectomy with pelvic lymphadenectomy.

A Clinical Study of Congenital Muscular Torticollis (선천성 사경 환자에 대한 임상적 고찰)

  • Kwon Chun-Suk
    • The Journal of Korean Physical Therapy
    • /
    • v.4 no.1
    • /
    • pp.19-25
    • /
    • 1992
  • The purposes of this study is to survey the clinical findings of congenital muscular torticollis. The subjects were 44 congenital muscular torticollis patients who were treated at physical therapy department of rehabilitation medicine, presbyterian medical center during the period Jan. Dec. 1991 The results were as follows : 1. Patients were evenly divided by gender(22 bodys, 22 girls). Left-sided involvement was found in 27 cases$(61.4\%)$, and right side in 17 cases$(38.6\%)$. 2. Abnormal delivery was 29 cases$(65.9\%)$. Those included resarean section, breech presentation with vaginal delivery and difficulty delivery. 3. Most of torticollis were primipara infant 33 cases$(75\%)$ 4. Associated congenital anomalies were noted in 12 cases, the most common cases were central co-ordination disturbance. 5. Patients was most commonly referred form the department of pediatrics. 6. Sternocleidomastoid fibrotic nodules were noted in 32 cases$(72.7\%)$. 7. Four cases had excision of the sternocleidomastoid fibrotic nodules in infancy and average at which operation was twelve months of life(range from nine months to fourteen months). 8. Facial asymmetry was noted in 13 cases at the begining of treatment, and the asymmetry was corrected after treatment in 10 cases. 9. The average duration of treatment was 3 months when the treatment was started in 3 weeks old. 10. The result was good in 22 cases$(50\%)$, fair in 12 Cases$(27.3\%)$.

  • PDF

Does Microinvasive Adenocarcinoma of Cervix Have Poorer Treatment Outcomes than Microinvasive Squamous Cell Carcinoma?

  • Ruengkhachorn, Irene;Hanamornroongruang, Suchanan;Leelaphatanadit, Chairat;Sangkarat, Suthi
    • Asian Pacific Journal of Cancer Prevention
    • /
    • v.17 no.8
    • /
    • pp.4013-4017
    • /
    • 2016
  • Background: To compare the pathological findings and oncologic outcomes of stage IA cervical carcinoma patients, between adenocarcinoma and squamous cell carcinoma cases. Materials and Methods: A total of 151 medical records of stage IA cervical carcinoma patients undergoing primary surgical treatment during 2006-2013 were reviewed. Information from pathological diagnosis and recurrence rates were compared with descriptive statistical analysis. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results: The median age was 48.9 years. There was no significant difference in rates of lymph node, parametrium, uterine, vaginal, or ovarian metastasis, when comparing adenocarcinoma with squamous cell carcinoma. Overall recurrence rates of adenocarcinoma (5.7%) and squamous cell carcinoma (2.6%) were not statistically significant different, even when stratified by stage. When comparing progression free survival with squamous cell carcinoma, adenocarcinoma had an HR of 0.448 (0.073-2.746), p=0.386. Conclusions: Microinvasive adenocarcinoma of cervix has similar rate of extracervical involvement and oncologic outcomes to squamous cell carcinoma.

A Therapeutic Experience of Congenital Bilateral Neuroblastoma (선천성 양측성 신경모세포종의 치료경험 1례)

  • Seo, Yeon Kyong;Kim, Heung Sik;Kwon, Kun Young;Lee, Hee Jung;Koo, Hong Hoe
    • Korean Journal of Pediatrics
    • /
    • v.46 no.12
    • /
    • pp.1279-1282
    • /
    • 2003
  • Neuroblastoma is the most common intraabdominal malignant tumor of childhood, with 40% arising from the adrenal gland. Bilateral adrenal involvement from synchronous development or metastatic spread of tumor is rarely seen in children with neuroblastoma. The patient was born with a spontaneous vaginal delivery. Birth weight was 3,200 g. Fetal ultrasonography showed a left adrenal cystic mass. At two weeks of age, she was admitted due to a massive abdominal distension and tachypnea. Percutaneous ultrasonography guided biopsy of the left adrenal mass was performed. The result of the biopsy was neuroblastoma. Vincristine and cyclophosphamide were administerd intravenously and 450 cGy of irradiation was added. Left adrenalectomy was accomplished and postoperative course was uneventful. The patient received cancer chemotherapy with a combination of carboplatin, ifosfamide and VP-16 and is now being followed up for three months. We have experienced a case of congenital bilateral neuroblastoma and report the case with brief review of related literatures.