YouTube as a Source of Information and Education on Hysterectomy

Background@#Globally, YouTube is one of the most popular websites, and the content is not restricted to entertainment. The purpose of this study was to assess the quality of information in YouTube videos pertaining to hysterectomy. @*Methods@#We explored YouTube using the search terms “hysterectomy” and “remove uterus.” The videos that appeared were sorted using the filter “sort by view count.” Of the initial 100 videos, the top 50 videos for each search term were included for review, as determined by the “relevance” filter based on YouTube's algorithm. After excluding 34 videos for various reasons, 66 were included in the final analysis. Each video rated as “useful” was further analyzed for reliability and completeness of information; a set of pre-determined criteria were modified from a previous study and used to grade the quality of videos. @*Results@#The top 66 videos on hysterectomy had a total of 4,679,118 views. Based on authorship, the videos were categorized as follows: videos uploaded by patients, 37%; academic videos, 35%; videos uploaded by physicians, 13%; commercial videos, 4%; and videos uploaded by non-physicians, 2%. The type of content was also categorized: 50% of the videos recorded personal experiences, 23% recorded surgical techniques, 21% involved explanations of the surgery, and 4% were commercial videos. The majority of the videos made by patients were negatively biased toward hysterectomy surgery (71.72%), while the majority of those made by academics or physicians were surgical educational videos for doctors, not patients. @*Conclusion@#YouTube is currently not an appropriate source for patients to gain information on hysterectomy. Physicians should be aware of the limitations and provide up-to-date and peer-reviewed content on the website.

History-indicated cerclage: the association between previous preterm history and cerclage outcome

OBJECTIVE: Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome. METHODS: We conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses. RESULTS: The incidence of preterm delivery (< 32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at < 32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively. CONCLUSION: Comparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.

Preoperative and postoperative serum C-reactive protein levels to predict the outcome of ultrasound-indicated cerclage

OBJECTIVE: To assess the role of preoperative and postoperative serum C-reactive protein (CRP) level on the prediction of pregnancy outcomes following ultrasound-indicated cerclage (UIC). METHODS: We retrospectively reviewed the medical records 44 women who underwent UIC between January 2011 and December 2011. UIC was performed between 14 and 24 weeks of gestation in women with short cervix. We divided UIC patients into two groups according to the gestational age at delivery (34 weeks) and compared the two groups. Group A was defined as patients who delivered ≥34 weeks of gestation, and group B as patients delivered <34 weeks. Correlation and receiver-operating characteristic curves were also analyzed for the prediction of preterm birth after UIC. RESULTS: Thirty women delivered ≥34 weeks (group A) and 14 women delivered <34 weeks (group B). Pre- and post-cerclage CRP were significantly lower in group A (pre-cerclage CRP, 1.1±1.0 vs. 11.4±6.2 mg/dL, P<0.001; post-cerclage CRP, 0.6±0.5 vs. 7.4±7.2 mg/dL, P<0.001). The mean gestational age at delivery in group A was 37.7±1.8 weeks and that in group B was 26.9±4.3 weeks (P<0.001). There were significant negative correlations between pre- and post-cerclage CRP and latency from UIC to delivery (r=-0.82, P<0.001; r=-0.70, P<0.001, respectively). CONCLUSION: Both pre- and post-cerclage CRP were useful in predicting the preterm birth following UIC.

Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia

OBJECTIVE: To assess the diagnostic accuracy of random urine protein-creatinine (P/C) ratio for prediction of significant proteinuria in preeclampsia as an alternative to the time-consuming 24-hour urine protein collection. METHODS: Retrospective record analysis was performed on 140 pregnant women who were admitted with suspicion for preeclampsia from January 2006 to June 2011. Random urine protein and/or 24-hour urine protein levels were assessed and their correlation to random urine P/C ratio and 24-hour urine protein excretion was evaluated. RESULTS: Out of 140 patients, random urine P/C ratio or/and 24-hour urine protein was performed in 79 patients to evaluate significant proteinuria. Of 79 patients, 46 (58%) underwent both tests whereas in 33 women (42%) 24-hour urine collection was not available due to urgent delivery. In 39 cases (85%), significant proteinuria (> or =300 mg/24 hr) was detected with 6 cases (13%) having values over 5,000 mg/24 hr, corresponding to the diagnosis of severe preeclampsia. Random urine P/C ratio highly correlated with 24-hour urine protein excretion (r=0.823, P<0.01). The optimal random urine P/C ratio cutoff points were 0.63 and 4.68 for 300 mg/24 hr and 5,000 mg/24 hr of protein excretion, respectively. with each sensitivity, specificity, and positive and negative predictive values of 87.1%, 100%, 100%, and 58.3%; and 100%, 85%, 50%, and 100%, for significant and severe preeclampsia, respectively. CONCLUSION: Random urine P/C ratio is a reliable indicator of significant proteinuria in preeclampsia and may be better at providing earlier diagnostic information than the 24-hour urine protein excretion with more accuracy than the urinary dipstick test.

A case of round ligament varicosities during pregnancy / 대한산부인과학회지

Estimated incidence of round ligament varicosities in pregnancy is not known and often times it is confused with inguinal hernia due to their clinical similarities. When a patient is presented with inguinal mass especially in association with varicosity in the genital region or lower extremity, round ligament varicosity must be considered as a plausible diagnosis. Depiction of "bag of worms" on color Doppler ultrasonography is diagnostic of the round ligament varicosity and it is known to resolve spontaneously following delivery. We report a case of round ligament varicosities that was diagnosed at 29 weeks of gestation with a brief review of the literatures.

A case of pulmonary sequestration mimicking mediastinal mass detected by prenatal ultrasonography / 대한산부인과학회지

Pulmonary sequestration is a developmental anomaly of broncho-pulmonary foregut with nonfunctioning parenchymal tissue, which usually supplied by systemic circulation. Pulmonary sequestration is detected by ultrasonography as a homogeneous echogenic mass and also by Doppler blood flow from systemic circulation to the mass. Pulmonary sequestration is classified into intralobar type and extralobar type. Extralobar type accounts for only 15~25% of the cases and it is subdivided into intrathoracic forms, which are most commonly found and extrathoracic type, which includes intraabdominal, retroperitoneal, or mediastinal masses. We report a rare case of prenatal detection of mediastinal mass with a brief review of literatures, which was confirmed to be a pulmonary sequestration by surgical mass excision after birth.

Diabetes mellitus following platinum-based chemotherapy in gynecologic cancer patients / 대한산부인과학회지

OBJECTIVE: To assess the association between platinum-based chemotherapy for gynecologic malignancy and the risk of diabetes mellitus. MATERIAL AND METHODS: We analyzed retrospectively the association between platinum-based chemotherapy and diabetes mellitus. Out of the 449 patients who received the chemotherapy in Severance Hospital from January 2002 to December 2005, 169 patients with serial measurements of fasting blood glucose throughout the chemotherapy period were enrolled in this study. The parameters that were analyzed included age, past history, family history, body mass index (BMI), serum glucose, type of cancer, chemotherapy regimen, dose cycle, time after cycle. We performed binomial test to compare the incidence in our patients with that of general population. RESULTS: In 8 patients (4.8%) diabetes mellitus developed during the treatment period. The median age of patients was 57 years, and the mean BMI was 27.0 kg/m2. All patients received platinum-based chemotherapy and seven of them received cisplatin based regimen and two patient was given carboplatin based regimen. Median cisplatin cumulative dose up until the diabetes mellitus occurred was 252 mg/m2 and that of carboplatin was 812 mg/m2. Median time until the diagnosis of diabetes mellitus after administration of the first chemotherapy cycle was 7 months. The overall incidence of hyperglycemia (4.8%) in patients treated with platinum-based chemotherapy is higher than the incidence of diabetes mellitus in the general population (2.1%). CONCLUSION: We suggest that regular monitoring of serum glucose levels which is not generally included in the pre-chemo lab values in patients receiving chemotherapy with platinum based regimen should be considered.

Spontaneous regression of the mild cervical dysplasia and its related factors / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the regression rate of the mild cervical dysplasia and to examine the factors associated with the regression. METHODS: One hundred and nine women pathologically confirmed with mild cervical dysplasia were recruited into this study. They were followed up by cytology, colposcopy and human papillomavirus DNA test at 3 months and 6 months after the diagnosis. The participants filled out a questionnaire on their demographic characteristics and sexual history. RESULTS: The rate of spontaneous regression for the mild cervical dysplasia was 59.6%(65/109). Multivariate analysis showed that initial ASCUS cytology, negative HPV status, non-smoker, condom user and age under 40 years old were associated with higher regression rate. CONCLUSIONS: The rate of regression for mild cervical dysplasia seen in our study was particularly higher than the result in previous study. Therefore, we recommend that the patients with mild cervical dysplasia can be followed up by cytology and HPV DNA study without any intervention, especially in young patients. Initial ASCUS cytology, negative HPV status, non-smoker, condom user and age under 40 years old were good related factors for regression.

A Case of T/Natural Killer Cell Lymphoma of the Uterine Cervix / 대한산부인과학회지

Non-Hodgkin's lymphoma presented as a malignancy of the uterine cervix is exceedingly rare disease and accounts for approximately only 0.12-0.6% of extranodal lymphomas. Most reported cases were B-cell lymphomas and there is no consensus on the management and prognosis of the disease because of its extreme rarity. Primary T/natural killer (NK)-cell lymphoma arising from the uterine cervix is scarcely encountered that, in the review of literature, only 1 case has been reported by Mhawech et al. We encountered a woman with T/NK-cell lymphoma involving the uterine cervix that initially presented with severe vaginal bleeding. Therefore, we report the case with a brief review of literature.