Clinical Study of Borderline Ovarian Malignancy / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study is to investigate the clinicopathologic characteristics and the risk factors affecting the recurrence in patients with borderline ovarian malignancy. METHODS: From January 1996 to January 2001, 37 patients with borderline tumors of the ovaries were retrospectively investigated in the Department of Obstetrics and Gynecology, Catholic University, Kangnam and Uijongbu St. Mary's Hospital. Several clinicopathologic factors including DNA ploicly was analyzed for the prognosis and recurrence. Analysis for the kinds of treatment and recurrence were conducted to test the prognostic significance of several clinicopathologic factors including DNA analysis. RESULTS: Histologically, 27 borderline tumors were serous, 9 were mucinous and 1 was mixed epithelial type. The FIGO stage I was 91.8% (34/37) and stageII was 8.2% (3/37). Mean value of CA125 in mucinous borderline malignancy was significantly higher (162.4 IU/mL) than serous types (52.2 IU/mL) (p35 IU/mL) were 56.3% (9/16) in serous type and 75% (6/8) in mucinous tumors. Ten of 13 cases with DNA flow cytometry showed aneuploidy (76.9%). When considering pathologic types between diploid and aneuploid groups, there were no statistically significant differences. However, the patients with old age (>40) were more likely to be aneuploid (p<0.05). Mean duration of follow-up investigation was 26 months after primary operation. In this period, only one patient with serous borderline tumor stage Ia had recurrence on the contra-lateral ovary at 13-month. CONCLUSION: Data from this study showed that the majority of borderline tumors have good prognosis. And young patients who have not completed childbearing can be safely treated with unilateral salpingo- oophorectomy and omentectomy in stage I diploid tumor. In ovarian bordeline tumors, further studies on DNA ploidy would be needed.

The Value of HPV detection as a Follow-up Modality after Treatment of Cervical Precanceous Lesions / 대한부인종양콜포스코피학회잡지

OBJECTIVES: After LEEP conization of cervical precancerous lesions, cytologic follow-up and colposcopy is frequently unsatisfactory. This study was performed to investigate the relationship between the presence of human papillomavirus (HPV) and abnormal follow-up results. METHODS: Between March 1995 and Feburary 1999, 98 patients treated by LEEP for cervical dysplasia and CIS were included. All patient had initially done HPV testing by Hybrid Capture System (Digene Co., U.S.A.). Patients were followed up with PAP, colposcopy and HPV test. RESULTS: After mean follow-up 10.9-month follow-up, 9 patients (9.2%) had the abnormal cytology (>ASCUS). After treatment, there were 2 abnormal cytologic follow-up cases (13.3%) in the groups of koilocytosis and CIN I in initial tissue pathology, 7 abnormal follow-up cases (8.4%) in groups of CIN II/III and CIS. There was no significant difference between the recurrence rates of these two group (P=0.27). The presence of high-risk HPV DNA after LEEP was done in 26 cases. Of the HPV-positive follow-up cases, 4 patients (50%) had abnormal cytologic results. But none had abnormal cytology in HPV-negative patients. CONCLUSION: Participants with positive follow-up HPV test have a higher recurrence rate than those with negative HPV test. Our study suggests the value of supplementary HPV DNA testing during follow-up of patients treated for cervical precancerous lesions.

Randomized comparison of the effects of the endocervical and the vaginal prostaglandinE2 in women with various degrees of cervical ripeness / 대한산부인과학회잡지

OBJECTIVES: The trial was performed to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostaglandin E2(PGE2) in the case of parous and nulliparous woman with favorable and unfavorable cervical features. This study was performed to determine the clinical usefullness of endocervical PGE2 comparing with the vaginal PGE2 in cervical ripening and induction of labor. METHOD: The randomized trial with 65 Participants was performed with sealed envelopes for parity and Bishop score (from March to september, 1998). PGE2 tablet(3mg Dinoprostone) was administrated intravaginally to the 32 pregnant women and endocervically to the 33 pregnant women every eight hours with maximum three times until the regular labor develped. RESULT: Outcomes of labor and delivery were clearly related to cervical score at trial entry. endocerval PGE2 had a more marked effect on cervical ripeness than did vaginal PGE2. There were no significant differences on age distribution, gestatioanal period, primiparity, cervical status, initial B-score in each group. There were no significant differences in cesarian section rate, fetal distress, uterine hyperstimulation, side effect and poor infant outcome between the groups The mean induction time was statistically shorter in cervical group with multiparous women than other group(p=0.0195). In the induction-active labor time, cervical with primi group was statistically shorter than other group(p=0.0245). Statistically significant differences were noted between the nulliparous woman and multiparous women in mean induction time, induction-active labor time, time to B-score 8. In the factor that effects induction-active labor, route was significantly better than other factor.(p=0.0001) CONCLUSION: edocervical PGE2 is more effctive than vaginal PGE2 in cervical ripening and induction of active labor. the endocervical PGE2 resulted in a significantly shorter induction to active labor time compared with vaginal PGE2 and has almost no side effect. Because differences in effectiveness between endocervical and vaginal PGE2 are marginal, preference of woman and clinicians can the choice between them.