A Study of Criminal Manifestation and Characteristics of Elderly Mental Illness

Objective@#As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. @*Methods@#From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. @*Results@#There was a statistically significant difference in the judgment of criminal liability according to the degree of cogni-tive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type ofmental illness (p<0.001). @*Conclusion@#Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.

A Study of Criminal Manifestation and Characteristics of Elderly Mental Illness

Objective@#As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. @*Methods@#From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. @*Results@#There was a statistically significant difference in the judgment of criminal liability according to the degree of cogni-tive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type ofmental illness (p<0.001). @*Conclusion@#Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.

Prognosis of pregnancy and perinatal outcomes in epileptic pregnant women used antiepileptic drugs / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the prognosis of pregnancy and perinatal outcomes of epileptic women used antiepileptic drugs. METHODS: A retrospective analysis of 66 consecutive pregnancies of 41 epileptic women from January 1989 through December 2005 was performed. The maternal and perinatal outcomes of pregnancies with epilepsy were compared with those of 1,000 normal pregnancies of similar age and parity occurred during the same period. We also compared the perinatal outcomes regarding protocol of antiepileptic drugs (monotherapy vs polytherapy), existence of gestational seizure, and duration of epileptic history. Statistical analyses with chi-square test and t-test were performed. RESULTS: In our comparison study between epilepsy and normal groups, with the exception of primigravida (43.8% vs 31.8%, p=0.009), induction of labor (43.1% vs 22.1%, p=0.001) and major congenital malformation (6.9% vs 2.0%, p=0.015), no other significant differences regarding maternal and perinatal outcomes were noted between two groups. There were no different obstetrical outcomes between monotherapy and polytherapy groups. In epileptic women with gestational seizure, the rate of fetal distress (20.0% vs 2.3%, p=0.02) was significantly increased. In longer epileptic history (> or =10 years), the rates of preterm birth, low birth weight, and major congenital malformation were increased, but there was no statistical significance. CONCLUSION: There are no increased maternal and perinatal complications in epileptic women used antiepileptic drugs, except for major congenital malformation.

The Feasibility Test of Korean Medication Algorithm for the Treatment with Schizophrenic Patients(III): The Influence of Therapeutic Environment on Application of Korean Medication Algorithm Project for Schizophrenia / 대한정신약물학회지

OBJECTIVE: Korean Medication Algorithm Project(KMAP) for schizophrenia was started in 2001. Phase II of this algorithm project for schizophrenia was a feasibility trial and was done to investigate suitability of the algorithm. The purpose of this paper was to evaluate the influence of the therapeutic environment in application of Korean medication algorithm project for schizophrenia. METHOD: A total 108 schizophrenic patients were enrolled at 16 general hospitals and at 3 mental hospitals. All subjects were treated and evaluated according to the algorithm. After the application of the algorithm, clinical effects, switching tendency of antipsychotics and degree of satisfaction for algorithm were compared between general hospitals and mental hospitals. RESULT: There were no significant demographic differences in the two hospital groups. But, cognitive and obsessive symptoms were significantly more severe in mental hospital patients. In general hospital, transitions between each treatment stages were more frequent than in mental hospital. After 4 months of antipsychotic medications trial, most patients were still in the stage 1 (83.3%) in mental hospital group compared to 51.85% of patients in general hospital group. After 4 months of algorithm trial, changes in PANSS (32.85+/-18.87) and CGI (3.47+/-1.81) in general hospital group were significantly greater than those in mental hospital group. Necessities of treatment algorithm were more emphasized by clinician working at the mental hospitals. Overall, degrees of satisfaction for treatment algorithm were not significantly different between two hospital groups. CONCLUSION: These results could be due to the different characteristics of patients or therapeutic environment between the two groups. Also, the resources needed to implement the algorithm may be different between the two groups. To use the Korean Medication Algorithm for schizophrenia with treatment as usual, the difference between therapeutic environments should be considered.

The Feasibility Test of Korean Medication Algorithm for the Treatment with Schizophrenic Patients(I): Analysis Focusing on the Effectiveness of Treatment / 대한정신약물학회지

OBJECTIVES: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for schizophrenia to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Schizophrenia patients in clinical settings in Korea. METHODS: A total of 108 schizophrenia and schizophreniform disorder patients were enrolled at 19 centers and treated according to the algorithm. PANSS (Positive and Negative Symptom Scale) and CGI (Clinical Global Impression) were used to evaluate symptom severity. Also UKU (UKU side effect rating scale) and LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale), DAI-10 (Drug Attitude Inventory-10), PPS (Patient Preference Scale), SWN (Subjective Well-Being under Neuroleptic treatment) and WHOQOL (World Health Organization Quality of Life) were used to evaluate tolerability and satisfaction of patient respectively. RESULTS: Overall ratings including symptom severity, compliance of medication, side effect of medication, quality of life were favorable. The treatment response (PANSS improvement > or = 20%) rate was 63%, 75% at the first Clinical decision point (CDP) and 4 month respectively. CONCLUSION: Symptom improvement, tolerability and quality of life were all favorable. These results suggest that this algorithm can be useful in clinical practices.

Updated treatment of vaginitis / 대한산부인과학회지

Three common vaginal infections are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomonas vaginitis (TV). However their symptoms and signs are similar and atypical and other non-infectious vaginal inflammations will be the causes of identical symptoms. Hence accurate diagnosis is the first step in management of vaginitis and then appropriate therapy should be conducted. Metronidazole is the drug of choice for the treatment of BV and TV. Topical or oral azole antifungal regimens are highly effective in reliving symptoms of VVC. Physicians who treat the woman having vaginitis should consider the fact that the disease may be chronic, frequent and recurrent due to antibiotics abuse and over the counter antimycotic agents. Also predisposing factors must be removed before medical therapy.

A clinical study on gestational trophoblastic disease / 부인종양

OBJECTIVE: To evaluate the clinical characteristics and the outcome of the management for gestational trophoblastic disease (GTD) patients diagnosed at our hospital and to report the current situation of GTD in Korea. METHODS: Between January, 1991, and December, 2000, One hundred and eleven women were diagnosed as GTD and managed in our hospital. Patients were classified according to clinical diagnosis and their medical records were investigated. RESULTS: Cases of benign, malignant nonmetastatic, malignant metastatic low risk and malignant metastatic high risk GTDs were 62, 36, 2 and 11 respectively. The mean age (year), gravidity and parity (number) of GTD patients were 33.3+/-9.9 (range: 19-54), 3.2+/-3.0 (range: 0-16) and 1.7+/-1.8 (range: 0-7) overall. About 75% of GTD patients were women in their 20s and 30s, and 85% occurred in patients with parity of 3 or less. The most common prior gestational event was abortion (37.1%) for molar pregnancy and molar pregnancy (61.2%) for persistent gestational trophoblastic tumor (PGTT). The progression rate of molar pregnancies to PGTT was 38.0%. MTX (16.3%) was mainly used as a single agent, and EMACO (28.6%) or MAC (22.4%) were primarily used for multidrug chemotherapy for the treatment of PGTT. In the treatment of PGTT, overall remission rate was 95.9% (n=47/49). CONCLUSION: The trends for GTD in Korea revealed significant changes, not only a decrease in the incidence of GTD, but also an improvement in the outcome of the management. There is a necessity of further community-based surveys for GTD.

Acute Alcohol Responses and Personality Traits by Aldehyde Dehydrogenase 2 Genotype Variances in Patients with Alcohol Dependence

OBJECTIVES: The purpose of this study is to evaluate the pathophysiology of alcoholics by investigating the differences in frequency of Aldehyde Dehydrogenase 2(ALDH2) genotypes and ALDH2 alleles between patients with alcohol dependence and controls, and the differences of drinking and personality traits in Korean male alcoholics with ALDH2 genotype variances. METHODS: The authors selected 98 patients with alcohol dependence and 53 controls. Self-report questionnaires for acute reponses after alcohol ingestion, the AUI(Alcohol Use Inventory), and the NEO-PI-R(NEO Personality Inventory Revised) were given to all patients with alcohol dependence. ALDH2 genotypes were typed with Mbo II RFLP(Restriction Fragment Length Polymorphism) method in 53 controls and 98 patients with alcohol dependence. The authors divided alcoholic patients into two groups according to the presence of variant ALDH22 allele; normal ALDH2 alcoholics(N=87) and variant ALDH2 alcoholics(N=11). RESULTS: 1) The genotypic frequencies of subjects with ALDH21/1 were higher and those with ALDH21/2 and ALDH22/2 were lower in patients than in controls. 2) Alcohol dependence could be found in ALDH22/2 homozygote individuals. 3) Variant ALDH2 alcoholics had more family problems in the AUI than normal ALDH2 alcoholics. 4) Variant ALDH2 alcoholics experienced more flushing and cardiovascular responses after alcohol ingestion than normal ALDH2 alcoholics. 5) Variant ALDH2 alcoholics had less altruistic personality traits in the NEO-PI-R than normal ALDH2 alcoholics. 6) Variant ALDH2 alcoholics tended to have more tolerance to alcohol than normal ALDH2 alcoholics. CONCLUSION: Variant ALDH22 allele might play a protective role in the pathogenesis of alcohol dependence and there were several significant differences of drinking and personality traits in Korean male alcoholics with ALDH2 genotype variances.

A Case of Multiple Umbilical Cord Cyst Associated with Intrauterine Fetal Death / 대한산부인과학회잡지

Cystic masses are among the most common sonographically detectable abnormalities of the umbilical cord. Umbilical cord cysts have been described in association with fetal anomalies, with chromosomal or structural defects being found in over 20% of cases. We present a case of umbilical cord cyst associated with fetal death at 29 weeks of gestation with a brief review of literatures.

Laparoscopic versus Laparotomic Management of Adnexal Tumor before Week 18 of Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the safety and benefit of laparoscopic surgery compared with laparotomy for the management of adnexal tumor during pregnancy. METHODS: We reviewed 54 cases of adnexal tumor during pregnancy which were managed surgically at Chonbuk National University Hospital between January 1996 and July 2002. Laparoscopy was performed in 17 patients. The remaining 37 patients had laparotomy. The medical records were reviewed retrospectively to confirm variable factors, such as gestational age, operating time, surgical methods, pathologic results, and pregnancy outcomes and complications. RESULTS: Mean gestational age at surgery was significantly different between two groups (85.2 vs 103.0 days). Operating time was not significantly different between two groups. Hospital stay (4.6 vs 7.0 days) was significantly shorter in the laparoscopy group than laparotomy group. No operative or postoperative maternal complications occured in the pregnant women who had laparoscopic surgery. Five preterm deliveries and one intrauterine fetal death occured in the laparotomy group. CONCLUSION: Comparing with laparotomy, laparoscopic surgery allows a shorter hospital stay, a reduced rate of postoperative complications and a maternal and fetal morbidity compared. Laparoscopic surgery appears to be safe and effective during pregnancy.

A Comparative Study of Oral and Vaginal Misoprostol Administration in Mid-trimester Pregnancy Termination / 대한산부인과학회잡지

OBJECTIVE: To compare the effectiveness of oral misoprostol with vaginal misoprostol administration in mid-trimester pregnancy termination after pretreatment with serial laminarias tenting. METHODS: This study was made in 50 patients for mid-trimester pregnancy termination at Department of Obstetrics and Gynecology, Chonbuk National University Hospital from January 1999 through December 2002. Twenty five women received misoprostol orally in a dose of 200 micro gram every hour for 3 doses followed by 400 micro gram every 4 hours after serial laminarias tenting. Twenty five women received misoprostol vaginally in a dose of 400 micro gram every 4 hours after serial laminarias tenting. Side effects of drug, induction to delivery interval, delivery numbers within 24 hours, curettage numbers for retained placenta, and the length of hospital stay were compared. RESULTS: The mean time of induction to delivery interval was significantly shorter in the vaginal group (15.5 +/- 12.7 vs 24.2 +/- 14.3 hours, p<0.01). The length of hospital stay was also shorter in the vaginal group (38.9 +/- 13.1 vs 47.2 +/- 14.5 hours, p<0.01). The number of patients delivered within 24 hours was more in the vaginal group (92 vs 72%, p<0.05). The side effects of misoprostol were slightly more common in the oral group than the vaginal group without statistical significance. CONCLUSION: We suspect that after serial tenting of laminarias, intravaginal misoprostol appears to be more safe and effective than oral misoprostol for mid-trimester termination.

A Case of Acardiac Twin Diagnosed by Ultrasound Prenatally / 대한산부인과학회잡지

The acardiac twin, or twin reversal of arterial perfusion (TRAP) sequence is encountered in approximately 1% of monozygotic twins with an incidence of one in 35,000 births. The problem results from vascular anastomoses between the arterial and venous circulation of normal "pump" twin and that of recipient "perfused" acardiac twin. The recipient twin may display severe and lethal anomalies, including acardia and acephalus. The pump twin is structurally normal. Mortality of about 50-75% in cases without treatment is due to heart failure, prematurity or cord entanglement. We report a case of acardiac twin diagnosed by ultrasound prenatally.

Antepartum Expectant Management of Placenta Previa, Inpatient Versus Outpatient / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the outcome of inpatient and outpatient management of placenta previa. METHODS: Sixty women with the initial diagnosis of placenta previa at 30 to 37 weeks' gestation who required hospitalization for no or minimal vaginal bleeding were stabilized and then randomized to receive either inpatient or outpatient expectant management. Thirty inpatients were treated at bed rest with minimal ambulation, received corticosteroids until 33 weeks of gestation and underwent ultrasonographic examination at 2 week intervals to assess fetal growth and placental location. Thirty outpatients were discharged after 2 or 3 days of hospitalization, and also received corticosteroids every week until 33 weeks of gestation and underwent ultrasonographic examination at 2 weeks intervals. All subjects who reached 37 weeks' gestation with persistent placenta previa underwent cesarean section electively. RESULTS: There were no differences between inpatients and outpatients for mean age, parity, gestational age at diagnosis, gestational age at first bleeding, and number of prior cesarean sections. There were no significant differences in the maternal and neonatal outcome measures as measured by time pregnancy prolonged, transfusions, cesarean hysterectomy, gestational age at delivery, birth weight, and neonatal morbidity. Significant difference observed only in maternal total hospital stay (p<0.01) as inpatient is 29.5+/-21.4 days and outpatient is 10.1+/-7.5 days. CONCLUSION: In selected patients, outpatient management of placenta previa can be reduced maternal total hospital stay. There were no apparent differences in the maternal and neonatal outcome of the two groups.

Prediction of Preterm Birth by Using Qualitative Fetal Fibronectin Test Combined with C-reactive Protein / 대한산부인과학회잡지

OBJECTIVE: The qualitative test of fibronectin of the cervices and vaginae as well as the C-reactive protein test of pregnant mothers with symptoms of preterm labor were performed in an attempt to examine clinical validity of these factors as predictable elements of preterm delivery. METHODS: This prospective study was conducted on ninety (90) single pregnancies of gestational age from 24 weeks and 1 day to 34 weeks and 6 days admitted to the hospital with symptoms of preterm labor, which occurred in the period from October 1, 1999 through March 31, 2001. Among these pregnant women, those with a uterine contraction rate of 4 per hour or greater and uterine dilatation of less than 3 cm without PROM were used as the subjects. The qualitative test of fetal fibronectin (ROM check, Adeza Biochemical, USA) of the cervices and vaginae as well as the C-reactive protein test by means of latex agglutination method using maternal blood were performed on these subjects. Of the 90 mothers that participated in this study, 15 dropped out and 75 underwent the qualitative test of fetal fibronectin and C-reactive protein test. The results of each test and the combined tests of both at preterm delivery (1) within 1 week, (2) prior to 34 weeks and (3) prior to 37 weeks were compared and analyzed. RESULTS: 1. 22.4% (15/67) resulted in preterm delivery prior to 34 weeks while 48.0% (36/75) ended up with preterm delivery prior to 37 weeks. 2. In predicting preterm delivery within 7 days and prior to 37 weeks after the test, the fetal fibronectin and C-reactive protein qualitative test were statistically insignificant. The combined tests of both fetal fibronectin and C-reactive protein were statistically insignificant in predicting preterm delivery within 7 days (Odds ratio of 4.2; 95% CI 0.7-23.3 p=0.199) and prior to 37 weeks (Odds ratio of 5.3; 95% CI 0.6-48.3 p=0.116). 3. In predicting preterm delivery prior to 34 weeks, fetal fibronectin and C-reactive protein qualitative test were insignificant statistically. Nevertheless, these two tests in combination showed a statistical significance for preterm delivery prior to 34 weeks: It showed a sensitivity of 26.7% (4/15), a specificity of 95.6% (43/45), a positive predictability of 66.7% (4/6), and negative predictability of 79.6% (43/53) [Odds ratio of 7.8; 95% CI 1.3-48.3, p=0.03]. CONCLUSION: Specificity and positive predictive value improved when the combined fetal fibronectin and C-reactive protein tests in pregnancies with symptoms of preterm labor were performed for preterm delivery before 34 weeks. Consequently, this is a clinically valid predictor of preterm delivery before the 34th week.

A Case of Spontaneous Renal Subcapsular Hematoma and Acute Renal Failure Developed after Cesarean Section with Severe Preeclampsia / 대한산부인과학회잡지

Spontaneous renal subcapsular hematoma is a rare, life-threatening condition that is usually caused by benign and malignant renal tumors, vascular diseases, inflammatory disorders, blood dyscrasias, and seldom suspected clinically. The characteristic clinical features are abdominal pain, a mass in the flank and signs of internal bleeding. Severe preeclampsia is also a major contributing factor of the renal hematoma. Because renal function is decreased in spontaneous renal subcapsular hematoma, physicians should be aware of the clinical symptoms and signs, appropriate investigation and management may be life-saving. This case of spontaneous renal subcapsular hematoma and acute renal failure complicated by severe preeclampsia, which occurred after delivery and was treated conservatively.

Neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes. METHODS: One hundred seventy patients who delivered neonates between 28 and 34 weeks' gestation after preterm premature rupture of membranes from January 1992 to July 2000 were reviewed retrospectively. Patients were divided into 3 groups on the basis of the following betamethasone exposures: (1) none (control subjects), (2) betamethasone 4 mg IM, IV simultaneously and then 4 mg IV q 8 hours for 24 hours (single course) and (3) weekly administration after initial single course (multiple courses). All included patients received prophylactic antibiotics for group B streptococci. The statistical analyses were done using x2 test, Fisher's exact test and one way analysis of variance (ANOVA). Multiple logistic regression analysis was performed to determine the confounding effect of the multiple variables those were considered as risk factors for neonatal sepsis. RESULTS: This study included 67 patients in the control group, 60 patients in the single course group, and 43 patients in the multiple courses group. The latency (p=.0001) was significantly longer in the patients exposed to multiple course than the patients in the control group and those in the single course group. No significant difference was demonstrated in the incidence of neonatal sepsis (p=.881) and postpartum endometritis (p=.619) among the three groups. Neonatal sepsis was significantly associated with clinical chorioamnionitis (p=.022). CONCLUSION: According to our data, multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes was not associated with the increased incidence of neonatal sepsis and postpartum endometritis.

A Comparison for Efficacy and Safety of Magnesium Sulfate(Magrose), Ritodrine Hydrochloride(Yutopar) and Nifedipine(Adalat) in the Management of Preterm Labor / 대한산부인과학회잡지

OBJECTIVES: The aim of this study was to compare the efficacy and safety of magnesium sulfate, ritodrine hydrochloride and nifedipine in the management of preterm labor. MATERIALS AND METHODS: 180 women with documented preterm labor were randomly assigned to receive magnesium sulfate (n=60), ritodrine hydrochloride (n=60) and nifedipine (n=60) as initial tocolytic therapy. 30 women with documented preterm labor were allocated to administer fluid only and bed rest as control group. Patient could be switched to another tocolytic regimen if they continued to have contractions or side effects. The main outcome variables examined were days gain in utero, success rate, side effects and neonatal outcome. RESULTS: There were no significant differences in maternal characteristics between the groups. The days gain in utero was no statistically different in the three groups(magnesium sulfate, ritodrine hydrochloride and nifedipine) but markedly longer in the three groups than the control group (p<.01). The total success rate was similar in the three groups, but side effects were much more in the magnesium sulfate and ritodrine group than the nifedipine group (p<.05). The respiratory distress syndrome in neonate was decreased in the three groups than the control group without statistical significance. CONCLUSION: Nifedipine is an effective, safe, and well-tolerated tocolytic agent. In this retrospective study, total success rate of controlling preterm labor was similar in the three groups, but patients who received nifedipine were less side effects than magnesium sulfate or ritodrine group.

Clinical Efficacy of High-risk HPV DNA Test Using Hybrid Capture System in Cervical Epithelial Cells / 대한부인종양콜포스코피학회잡지

Human papillomavirus(HPV) has implicated in the development of cervical cancer. Several studies has suggested a strong correlation between HPV 16, 18 and cervical intraepithelial neoplasia(CIN). For detecting and typing HPV DNA in cervical tissues, recently the chemiluminescent molecular hybridization assay method has been widely used. This study was performed to determine the usefulness of hybrid capture assay for detecting high-risk HPV in cervical epithelial cells, and to compare the correlation among cervical cytology, biopsy finding and HPV infection, and to determine whether the addition of the hybrid capture assay to cytologic test would improve the ability to identify significant lesions. This study included 267 patients who visited the colposcopic clinic of the department of obstetrics and gynecology, Chonbuk University Hospital from May, 1997 to October 199S. Pap smears hybrid capture assays, and colposcopically directed biopsy were performed concurrently on al1 women. The results obtained were as follow; l. Using hybrid capture assay, the detection rate of high-risk HPV of all patients was 37.1%(99/267). There was no statistical significance in the detection rate of HPV between the age groups. 2. The false negative rate of Pap Smear was 53.3% and showed significant discrepancies between the cytologic and histologic diagnosis. 3. According to the cytologic diagnosis, the detection rates of high-risk HPV were 7.1% in normal, 25.3% in ASCUS or LSIL, and 61.6% in HSIL. In each cytologic group, the patients who had positive results for high-risk HPV showed higher incidence rate of high grade lesions than those with negative results(P<0.05). 4. According to the histologic diagnosis, the detection rates of high-risk HPV were 0.1% in normal, 11.1% in CIN I, and 72.7% in CIN II or CIN III. In each histologic group, the patients who had positive results for high-risk HPV showed higher incidence rate of high grade lesions than those with negative results(P<0.05). 5. According to the comparison of histologic diagnosis between positive and negative results of high-risk HPV test due to each cytology, there was no statistical significance in the incidence rate of cervical neoplasia, Above results suggest that high-risk HPV test using hybrid capture assay may be a useful method in supplement the pitfalls of cervical cytology. This test might also have prognostic value in the management of patients with CIN.

Treatment of Drug Abuse-Therapeutic Community

No abstract available.

Vaginal Birth after Cesarean Section / 대한주산의학회잡지

Repeat cesarean section is one of the leading causes to make increasing a rate of cesarean section. Trial of labor TOL after cesarean section is attempt to reduce the rate of repeat cesarean section. Trial of labor has been well established as a safe alternative in carefully selected women with transverse scars in the lower uterine segment. This study was based on 104 cases of delivery with prior cesarean birth at the Chonbuk National University Hospital from January, 1991 to June, 1997. The results were as follows: 1) Among 1400 cases with previous cesarean delivery, trial of labor was done in 104 cases (7.4%). Among 104 cases, vaginal birth was successfully completed in 96 cases (92.3%). 2) Among 28 cases with PGE2, vaginal tablet, vaginal delivery was done in 23 cases (82.1%). 3) Among 22 cases with more than 4 of Bishop score, vaginal delivery was done in 21 cases (95.5%), and among 6 cases with less than 3 of Bishop score, vaginal delivery was done only 2 cases (33.3%). 4) There was no matemal death or uterine rupture in the cases of trial of labor, But in 2 cases, uterine dehiscence was observed in 4 cases and postpartal bleeding (more than 400ml) was developed. 5) In the cases of cesarean section, mean of hospital day was 7 days and medical fee was about 400,000 won. In the cases of vaginal birth after cesarean section, mean of hospital day was 2.6 days and medical fee was about 100,000 won. In condusion, vaginal birth after cesarean section is safe and effective alternative to elective repeat cesarean section and also the use of PGE, vaginal tablet is so effective to increase success rate of vaginal delivery. After all, positive these trials might decrease cesarean rate and increase maternal health and quality of medical care.