A Case of Pelvic Lymph Node Metastases in Cervical Carcinoma with Early Stromal Invasion / 대한산부인과학회잡지

The definition and management of microinvasive cervical cancer varies from time to time depending on the organization involved and is a persistent focus of controversy. The purpose of defining microinvasion is to identify a group of patients who are not at risk of lymph node metastases or recurrence and who therefore may be treated with less than radical therapy. Microinvasive cervical cancer with

A Study on Menstrual Index of Korean Women / 대한산부인과학회잡지

OBJECTIVE: This study was designed to evaluate the patterns of menstruation including menorrhagia using menstrual index, to find out correlations between patient's own judgement and actual patterns of menstruation in Korean women, and to develop the menstrual diary using menstrual index as a screening of menstrual disorders. METHODS: Seventy-seven women teachers of elementary school undergoing routine health screening test were asked to complete a pictorial blood loss assessment chart and a set of interview sheets regarding menstrual history and their subjective judgement on their amount of menstruation. Spearman correlation test was used to assess the correlation between menstrual index which was obtained from pictorial chart and serum hemoglobin concentration. RESULTS: The mean menstrual intervals were 29.8 days (SD+/-5.1), the mean menstrual duration was 5.6 days (SD+/-1.3), the mean value of menstrual index was 170.3 (SD+/-89.2) which varied from 12 to 411, the mean serum hemoglobin concentration was 12.3 g/dL. Significant correlation was found between the serum hemoglobin concentration and the menstrual index (r=-0.29, p=0.01). Seventeen of 20 women who had anemia (serum hemoglobin concentration below 12.0 g/dL) and 25 of 26 women who had menorrhagia (menstrual index above 200) considered her menstruation as 'normal'. CONCLUSION: Many women who have anemia due to menorrhagia are not aware of the serious consequences of menorrhagia. Writing a 'menstrual diary' using menstrual index would be easier and more practical method in predicting menorrhagia.

Extremely elevated serum CA-125 concentration in patient with unruptured endometrioma A Case Report and Review of the Literature / 대한산부인과학회잡지

CA-125 is an antigenic determinant expressed by more than 80% epithelial ovarian cancer. Although developed for use in the diagnosis and monitoring of epithelial ovarian cancer, elevations of CA-125 concentrations can also be associated with some normal physiologic conditions, various other malignancies and benign conditions. Adnexal cysts are frequently encountered during the reproductive years. 10 to 35% of benign cystic adnexal masses may be an endometrioma. Because endometriomas are not likely to resolve spontaneously, and may enlarge or rupture during period of observation, a test to detect an endometrioma would assist in the evaluation and management of adnexal cysts. Serum CA-125 concentration is seldom >100 U/ml in endometriosis. We reported a patient with endometrioma presenting with a very high CA-125 concentration, which may confuse diagnosis with ovarian cancer.

A case of successful treatment of an ectopic pregnancy embedded in the myometrium of previous cesarean section scar with systemic methotrexate injection / 대한산부인과학회잡지

Intramural pregnancy implanting in the previous cesarean section scar is one of the rarest form of an ectopic pregnancy and probably the most dangerous form because of its risk of rupture and hemorrhage. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contact of endometrium. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are highly desirable. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, treated completely with systemic methotrexate injection. So, we report this case with a brief review of the literature.

A Case of Clear Cell Carcinoma of Endometrium / 대한산부인과학회잡지

Clear cell carcinoma of the endometrium is a relatively rare malignancy that is considered to be one of the most aggressive types of endometrial carcinoma. It is an infrequent variant sharing a common Mullerian origin, accounting for 1 to 5 percent of all endometrial cancers. Histologically, these tumors consists of hobnail cells which have translucent or slightly eosinophilic cytoplasm and protrude to lumen of gland. These tumors occur predominantly in postmenopausal women and carry a relatively unfavorable prognosis comparing with other histologic types of endometrial cancer. We experienced a case of clear cell carcinoma of endometrium in a 81-year old women and this case is presented with a brief review of the literaturs.

Hybrid Capture System HPV DNA Test as a Screening Tool of Cervical Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Although the use of cytology in screening has reduced morbidity and mortality from invasive cervical cancer, there has been limitation because of the low sensitivity and high false negative rate in the detection of preclinical or clinical disease of the cervix. This study was performed to explore the usefulness of Hybrid Capture System HPV DNA test as a diagnostic method of the cervical cancer. METHODS: Cervical cytology and Hybrid Capture System 1 (HCS1) HPV DNA test were performed in 1,023 women who visited Gynecologic Oncology Clinic in Guro Hospital, Korea University Medical Center. HPV DNA were retested by HCS1, HCS2 and Polymerase Chain Reaction(PCR), in randomly selected 200 women to compare these DNA tests. RESULTS: While the sensitivity and specificity of cervical cytology in detection of cervical lesion were 71.2% and 89.5%, those of HCS1 HPV DNA test were 63.0% and 86.9% respectively. There was significant difference in detection of cervical precancerous lesions between HCS1 and HCS2 (P<0.05), but not between HCS2 and PCR (P=0.14). And the sensitivity and specificity were improved with combining cytology and HCS1 HPV DNA test(82.2%, 86.9%~). CONCLUSION: HCS HPV DNA test may be considered as a useful adjunctive test with cervical cytology in cervical cancer screening.

Epithelioid trophoblastic tumor: A Case Report and Review of the Literature / 대한산부인과학회잡지

Epithelioid trophoblastic tumor (ETT) is an unusual variant of gestational trophoblastic tumor that is closely related to choriocarcinoma and placental site trophoblastic tumor (PSTT) but shows different morphologic, immunohistochemical features. ETT grows in a nodular pattern compared with the infiltrative pattern of PSTT. Histologically the tumor is characterized by uniform population of mononucleate intermediate trophoblastic cells that resemble the trophoblastic cells in the chorionic laeve, so we called them "chorionic-type intermediate trophoblast". Immunohistochemically ETT was positive for cytokeratin, epithelial membrane antigen(EMA) and staining for human placental lactogen (hPL) and human chorionic gonadotrophin (hCG) was generally patchy, focal or negative whereas PSTT contained more hPL-positive cells than hCG-positive cells. ETT can behave in a malignant fashion such as distant metastasis. We experienced a case of ETT by clinical result, pathologic finding, so we report a case with brief literature review.

Combined intrauterine and cervical pregnancy / 대한산부인과학회잡지

Although recently the incidence of heterotopic pregnancies are increasing because of assisted reproduction, heterotopyic pregnancies were rare with an incidence of 1 per 30,000 pregnancies. In this presentation, we describe a case of combined intrauterine and cervical pregnancy after artificial abortion. The patient was treated by local injection of methotrexate directly into gestational sac under the guidance of sonogram after systemic methotrexate treatment. The gestational products were removed by dilatation & currettage due to persistent vaginal bleeding on the next day. So we report a case with a brief review of the literatures.

Amifostine Pretreatment for Protection against Cisplatin-based Combination Chemotherapy in Gynecologic Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.

Amifostine Pretreatment for Protection against Cisplatin-based Combination Chemotherapy in Gynecologic Cancer Patients / 대한산부인과학회잡지

OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.

Unscheduled vaginal bleeding and associated gynecologic care in postmenopausal women using hormone replacement therapy: comparison of cyclic versus continuous combined regimen / 대한산부인과학회잡지

OBJECTIVE: To measure gynecologic resources required to care for women who have unscheduled vaginal bleeding while using hormone replacement therapy. MATERIALS AND METHODS: Between January 1996 to December 1998, women presenting with abnormal withdrawal bleeding on HRT were identified and associated clinic visits and gynecologic procedures were recorded during a mean follow-up of 2 years. RESULTS: Among women using cyclic HRT, 28.9% had> OR =1 visit for unscheduled vaginal bleeding 8.7% had> OR =1 endometrial biopsy. Among women using continuous combined HRT, 19.3% had> OR =1 visit for unscheduled vaginal bleeding and 6.4% had> OR =1 endometrial biopsy. The gynecologic procedures used in women using cyclic HRT were 20% of reassurance, 50% of ultrasonograpy, 30% of endometrial biopsy and in women using continuous combined HRT were 50% of reassurance, 16.6% of ultrasonograpy, 33.3% of endometrial biopsy. The results of endometrial biopsy were reported all the benign condition. CONCLUSION(S): Unscheduled vaginal bleeding markedly decreased after 12 months of therapy in women using continuous combined HRT but did not decline among those using cyclic HRT.

Levels of Insulin - like Growth Factor 1 ( IGF - 1 ) , Insulin - like Growth Factor Binding Protein 3 ( IGFBP - 3 ) , Osteocalcin and Deoxypyridinoline biochemical markers in either surgical menopause or natural menopause women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate possible menopause related changes in circulating insulin-like growth factor binding protein 3 (IGFBP-3) levels and their relationship with insulin-like growth factor 1 (IGF-1) plasma levels, osteocalcin(Ost) and urinary deoxypyridinoline(Dpd) in either surgical menopause or natural menopause, METHOD: Seventy-two postmenopausal women (surgical menopause 48, natural menopause 24) were invited to participate in this study. In all subjects plasma IGF-1 and IGFBP-3 levels were measSURED by radioimmunoassay and Ost and Dpd were measured by enzyme linked immunosorbent assay(ELISA). RESULTS: No difference was found between mean IGFBP-3 plasma levels in the two groups studied(3,522 +/- 926 vs 3,854 +/- 569 ng/ml), while mean IGF-1 levels were significantly lower in natural menopause as compared with surgical menopause (natural 126 +/- 44 vs surgical 163 +/- 66 ng/ml, p=0.007). No difference was found between mean Ost levels in the two groups studied (natural menopause 8.0 +/- 2.9 vs surgical menopause 8,9 +/- 2.1 ng/ml, p=0.113) and mean Dpd levels in the two studied (natural menopause 6.8 +/- 2.3 vs surgical menopause 7.8 +/- 3.4 mM, p=0.213). CONCLUSION: IGF-1 was significantly lower in natural menopause as compared with surgical menopause, but no significant difference was found in IGFBP-3, Ost, and Dpd levels

Diagnostic and Prognostic Value of Umbilical and Descending Thoracic Aorta Velocimetry / 대한산부인과학회잡지

OBJECTIVES: Early diagnosis of intrauterine growth retardation is important to ensure optimal monitoring and delivery with the introduction of real-time and Doppler ultrasound systems, a noninvasive method of measuring human fetal blood flow has become available. The aim of this study is to compare blood flow velocity waveforms at the fetal descending aorta and umbilical artery in normal and in patients with pregnancy induced hypertension. METHODS: Using a combination of linear array real-time and pulsed Doppler ultrasound, blood flow velocity measurements were carried out at the fetal descending aorta and umbilical artery in 35 normal pregnancies and 18 cases of pregnancy induced hypertensive patients. RESULTS: The mean systolic/diastolic ratio of umbilical artery and aorta was significantly higher in PIH patients than in normal pregnancies(3.8 +/- 0.81 versus 2.97 +/- 0.52, p<0.05) and to predict perinatal morbidity, umbilical velocimetry is more sensitive than that of descending thoracic aorta. CONCLUSION: This study suggests that umbilical artery velocimetry could be used as a marker to predict adverse perinatal outcome.

The Effects of Conjugated Equine Estrogens Plus Dydrogesterone on Lipid and Bone Metabolism inPostmenopausal Women / 대한산부인과학회잡지

The addition of a monthly course of progesterone decrease the incidence of endometrialhyperplasia and endometrial carcinoma. The progesterones used in hormonal replacementtherapy(HRT) differ markedly in their progesteronic, androgenic and even estrogenicactivities. These characteristics may influence both symptomatic and metabolic side effects.The purpose of this study was to examine effect of bone and lipid metabolism inpostmenopausal women treated with conjugated equine estrogens plus dydrogesterone.A total 131 postmenopausal women(surgical menopause=95, natural menopause=36)and not-treated postmenopausal women(control=22) were invited to participate in thisstudy. Patients were divided into groups which had received conjugated equine estrogen(CEE)0.625 mg/day 21-day-cycle each month(n=20), CEE 0.625 mg/day plus Dydrogesterone 10mg/day 10-day-cycle each month(n=111), and no treatment control group(n=20).Serum lipid and lipoprotein(Triglyceride, Total cholesterol, High density lipoprotein, Lowdensity lipoprotein) and serum osteocalcin, urinary Deoxypyridinoline were examined in allpatients.There were no significant differences in bone and lipid metabolism between CEE andCEE plus Dydrogesterone groups.In conclusion, Dydrogesterone may be used safely in postmenopausal women withoutMetabolic side effect.

Analysis of 1,046 Cases of Midtrimester Genetic Amniocentesis / 대한산부인과학회잡지

Prenatal diagnosis of genetic disorders is now an established part of routine antenatalcare. This is a study of our experience with 1,046 cases that have been undergone amniocentesisat the Guro Hospital of the Korea University Medical School from October 1983 toJune 1996. Advanced maternal age was by far the most common indication of amniocentesis.Chromosomal aberrations were diagnosed in 15 cases(1.4%) of which numerical aberrationwas 9 cases(60/0%) and structural aberration was 6 cases(40.0%). Autosomal aberrationwas observed in fourteen cases(93.3%) and sex chromosomal aberration was observedin one case(6.7%). Among the 14 autosomal aberrations, trisomy 21 was most common,being 5 cases, and one case of trisomy 13 and another case of trisomy 18 was found respectively.The others were 4 cases of translocation, one case of inversion and another case ofisochromosome. Sex chomosomal aberration case was only one and it was a Klinefeltersyndrome.

Study on Comparison between Traditional Technique of Cesarean Section and FAST: Finger Assisted Stretching Technique / 대한산부인과학회잡지

The cesarean section has been considered as one of the most prime and most commonly performed operations in the obstetrics and gynecology field. In fact, all cesarean sections have depended upon the operator`s experience. However, there have been several cases reported on new technique of cesarean section in many developed countries, but not in Korea until we started the recent research. We have developed a new type of cesarean section named FAST(Finger Assisted Stretching Technique) through study on strength/weakness of other operation techniques as well as many other researches we conducted in the past plus our own experiences. To find the differences on the following subjects; operating time, postoperative complication, and recovery period. We compared and analyzed data from using new and traditional techniques. We selected 120 patients(group A using FAST: 45 patients, group B using traditional technique: 75 patients) as samples for this study. Together, they were all conducted cesarean section at Korea University, Guro Hospital between May 1993 and December 1995. Student-t-test and chi-square test were used for statistical analysis. We consider that below 0.05 for P value is statistically significant. The results of comparative study between two groups are; 1. There was no comparative difference on average age: group A: 29.6(range 23~39, S/D 7.1) group B: 31.1(range 24~38, S/D 5.4) 2. There was a significant difference on average operation times: group A: 15.4 min.(range 11~19, S/D 3.6) group B: 41.3 min.(range 23~50, S/D 19) 3. There was a significant difference on average amount of bleeding: group A: 580 ml(range 450~750, S/D 101) group B: 916 ml(range 800~1000, S/D 99) 4. There was a significant difference on the value of hemoglobin before and after operation group A: 0.8 g/dl(range 0.4~1.6, S/D 0.25) group B: 1.9 g/dl(range 0.9~2.6, S/D 0.21) 5. There was a significant difference on average period of hospitalization: group A: 3.7 days(range 3~4, S/D 0.7) group B: 6.4 days(range 5~8, S/D 0.6) 6. No one from group A experienced any infection, but 3 cases of wound infection and 2 cases of voiding difficulty were reported from group B. 7. 11 cases from group A and 16 cases from group B had laparotomy for some other reasons, later. There was no adhesion found in group A, but adhesions found in 2 cases from group B.

A Clinical Study on the Effect and Toxicity of rhGM-CSF / 대한부인종양콜포스코피학회잡지

Dosage reinforcement of chemotherapeutic agent is thought to be a solution in treating many malignancies, including ovarian cancer and cervical cancer. The remission rate after administration of chemotherapeutic agents has a positive correlation with dosage and in cases where limitations were put on dosage, improved survival rate was achieved with dose-intensive therapy facilitated by autologous bone marrow transplantation(BMT) or the use of cytokines such as G-CSF. Our objectives are to evaluate therapeutic efficacy and toxicity of GM-CSF and to elucidate the effect of premedication which was administered to minimize the toxicity of the GM-CSF. Total number of patients entered into this study was fifty two and they are consisted of thirty seven patients of the uterine cervix, fourteen patients of ovarian cancer and one endometrial cancer patient. The increase in neutrophil count and WBC count was found to be statistically valid, but the changes in the number of platelets, hemoglobin, neutrophil and monocytes were not shown to be meaningful when statistics are brought in. Administration of GM-CSF resulted in mild toxicities such as myalgia, fever, skin reaction and neuropathy. But, one patient had grade 3 myalgia. Premedication brought about meaningful reductions in the toxicities of GM-CSF and can be used safely to reduce the toxicities.

Comparison of Five Sampling Methods of Cervical Cytology in Premaligant Lesions of the Uterine Cervix / 대한부인종양콜포스코피학회잡지

Fourty three patients known to hnve cervical intraepithelial neoplasia were assigned to Papanicolaou smear in five different ways, i, e, A) cotion tipped wood applieator at the pasterior vaginal fronix and the ectocervix, B) cotton tipped wood applicator at the ectocervix and the endocervical canal, C) Cytohrush at the endocervical canal, D) Cervexbrusk and E) Cyto-spatula. At the completion of cytologic study, all the subjects were done colposcopically directed biopsy and/or ECC. To evaluate the false negative rates of the cytologic test, cervical cone biopsy or hysteectorny was performed on all the patient. The false negat,ive rates were 53.5% in A) 39.5% in B), 14,0% in C), l8.6% in D), 25.6% in E) and statistical differences occurect between each group, It was also found that bleedings were most frequently endountered in E) and the encocervical cells were most frequently appeared in C). With these results, it can he stated that the rate of negative encocervical cells in the srnear were correlated with the false negative rates of cervical cytology.

A fruitful case of pregnancy by simplified GIFT procedure with tuboplasty / 대한산부인과학회잡지

No abstract available.

Comparison of plasma fibronectin in preeclampsia of before delivery and post delivery / 대한주산의학회잡지

No abstract available.