Laparoscopically assisted vaginal hysterectomy using 3-trocar method through the previous operation scar for large uterus weighing 300 g or more / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to examine the feasibility and safety of laparoscopically assisted vaginal hysterectomy (LAVH) using 3-trocar method through the previous operation scar for uterus weighing 300 g or more in the management of gynecologic disease. METHODS: This retrospective study was peformed in 51 cases of LAVH with uterus weighing 300 g or more and with symptomatic benign gynecologic diseases (leiomyoma or adenomyosis). LAVH was performed through 3-trocar method (one trocar below the umbilicus, and two trocars at the point about 2 cm above and medial side of each anterior superior iliac spine, or at the bilateral edges of the previous operation scar). RESULTS: Previous operation history was found in 17 cases (33.3%) and cesarean section was the most common. There was no difference in the age, body mass index, parity, length of operation, amount of blood loss, hemoglobin change, length of gas out, and hospital stay, rate of transfusion and complication between two groups divided by history of operation (P>0.05). Uterine weight in the group having operation history was lighter than that in group having not operation history (519.91+/-220.53 g and 381.24+/-70.63 g, respectively, P<0.05). CONCLUSION: LAVH for large uterus weighing 300 g or more using 3-trocar method through previous operation scar is safe and effective operation method, and may be an alternative to abdominal hysterectomy in selected patients.

Two cases of paratubal cysts manifesting as huge pelvic masses in young women / 대한산부인과학회지

Paratubal cysts come from paraovarium of the broad ligament between the fallopian tube and ovary. Overall, these cysts constitute 10% of all adnexal masses and are commonly incidental findings upon surgical exploration for other reasons. They more commonly occur in women between 30 and 40 years of age. We report two cases of rapidly growing, huge paratubal cysts in young women, which are presented with brief review of literature.

Evaluation of the factors affecting the success of the trial of vaginal birth and duration of labor in women with previous cesarean section / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor, to evaluate the risks of VBAC and to evaluate the criteria of dystocia and the safety of VBAC. METHODS: This retrospective study was peformed based on 61 pregnant women who succeeded VBAC, 37 VBAC failure women, 100 nulliparas and 100 multiparas. RESULTS: In clinical characteristics, the parity, the number of previous cesarean section, gestational age, estimated fetal body weight by ultrasonography, and neonatal body weight had notable differences between the success and the failure group. In obstetric and historical factors, cervical effacement, dilation, and Bishop score at admission, spontaneous labor and method of induction of labor had differences. Among these factors, estimated fetal body weight by ultrasonography, cervical effacement and augmentation of labor using oxytocin were the most prognostic factors affecting the success of VBAC. In VBAC group, the duration of active-phase, second phase and total duration of labor were 313.5, 36.4 and 350.2 minutes, which were significantly shorter than nulliparas, but longer than multiparas. CONCLUSION: The trial of labor after cesarean section will decrease repeat operation, if it is performed under exact understanding of successful prognostic factors and the unique time length of labor. It will contribute to increase advantages for mother and economic benefits.

Knowledge regarding cervical cancer, human papillomavirus and future acceptance of vaccination among girls in their late teens in Korea / 대한산부인과학회지

OBJECTIVE: The aim of this study is as follows; First, to assess knowledge regarding cervical cancer, HPV and the acceptance of HPV vaccination among girls in their late teens in Seoul, Korea. Second, to find out factors affecting the acceptance of HPV vaccination. METHOD: From November to December 2006, we surveyed Ewha Womans University freshmen and third year female students of Keumran High school affiliated with Ewha Womans University. A written questionnaire was sent to 310 students and 275 students responded. The questionnaire was divided into three sections that sought information about the followings : (1) Demographic characteristics; (2) Knowledge regarding cervical Pap smear testing and cervical cancer; (3) Knowledge regarding HPV and HPV vaccines. We scored the questionnaire giving one point for each correct answer. We summed up scores of knowledge on each section and compared the scores according to the acceptance of HPV vaccination in target group. RESULTS: The mean score of knowledge regarding cervical Pap smear testing and cervical cancer, HPV and HPV vaccines were 5.31+/-1.48 and 3.11+/-2.09, respectively. None of the demographic characteristics influenced the acceptance of HPV vaccine. The level of knowledge regarding HPV and HPV vaccines significantly affected the acceptance of HPV vaccine, however, knowledge regarding cervical Pap smear testing and cervical cancer did not. CONCLUSION: This study emphasize the need for further education regarding HPV infection and HPV vaccination for improvement in HPV vaccine acceptance.

Expression of Angiopoietin-1 and -2 and Tie-2 mRNA in Uterine Endometrial Cancer / 대한산부인과학회지

OBJECTIVE: This study was purposed to investigate the expression of angiopoietin (Ang) -1 and -2 and Tie-2 mRNA among uterine endometrial cancer, endometrial hyperplasia, and normal endometrium, and to assess the relationships among their expression and other prognostic factors of uterine endometrial cancer. METHODS: The tissues were obtained from patients with uterine endometrial cancer, patients with endometrial hyperplasia, and patients with normal endometrium undergoing hysterectomy. Total RNA was extracted and reverse transcribed into cDNA. Reverse transcription polymerase chain reaction (RT-PCR) and quantitative competitive-PCR (QC-PCR) were performed to evaluate the mRNA expressions of Ang-1 and -2 and Tie-2. Clinicopathologic factors of uterine endometrial cancer were reviewed with the patient's charts and results were analyzed with Mann-Whitney U test, Spearman correlation test and logistic regression analysis. RESULTS: Ang-1 and -2 mRNA expression in uetrine endometrial cancer were higher than that in endometrial hyperplasia and lower than that in normal endometrium (p<0.05), but there was no significant difference in Tie-2 mRNA expression among uterine endometrial cancer, endometrial hyperplasia, and normal endometrium. A definite correlation was found between Ang-1 mRNA expression and clinical stage and CA-125 levels of uterine endometrial cancer (p<0.05). CONCLUSION: The expression of Ang-1 and -2 mRNA could be associated with the progression of uterine endometrial cancer and might have a role as prognostic parameters in uterine endometrial cancer.

The Study of 5,10-Methylenetetrahydrofolate Reductase Polymorphism and Its Effect on Pregnancy Outcomes among the Korean Population / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to analyze MTHFR polymorphism among the Korean population and to evaluate the relationship between serum levels of homocysteine and MTHFR polymorphism and also to investigate the effect on pregnancy outcomes. METHODS: DNA was extracted from whole blood of 600 pregnant women. All samples were genotyped for the C677T and A1298C polymorphisms in MTHFR gene by PCR-RELP assay. Serum levels of homocysteine and folate were measured by high performance liquid chromatography for homocysteine and radioassay for folate. Pregnancy outcomes were estimated by gestational weeks and birth weights of newborns. RESULTS: Serum homocysteine was higher in women with the T/T genotype than those with the C/T or C/C genotype of the MTHFR C677T polymorphism (p<0.05). And also serum homocysteine was higher in women with the A/A genotype than those with the A/C or C/C genotype of the MTHFR A1298C polymorphism (p<0.05). Serum homocysteine was negatively correlated with serum folate in all MTHFR genotypes, especially prominent in T/T genotype of MTHFR C677T polymorphism and A/A genotype of MTHFR A1298C polymorphism. Gestational age and the birth weight of infant from hyperhomocysteinemic mothers whose homocysteine levels higher than 15 micromol/L were 36.1 weeks, 3053.8g, respectively, which were significant lower than those from normohomocysteinemic mothers (38.3 weeks, 3,215.3g) (p<0.05). CONCLUSION: Serum homocysteine was influenced significantly by MTHFR C677T polymorphism and MTHFR A1298C polymorphism. MTHFR C677T and A1298C polymorphism and serum homocysteine levels affect pregnancy outcomes, although not mainly by serum folate level.

Fetal pulmonary sequestration complicated hydrops: Successful fetal therapy by thoracoamniotic shunting / 대한산부인과학회지

Pulmonary sequestration is development mass of nonfunctioning bronchopulmonary tissue that is separate from the normal tracheobroncheal tree and receives arterial blood from the systemic circulation. Pulmonary sequestration has an excellent prognosis and frequently can be seen to regress spontaneously on serial prenatal sonogram. But in cases with hydrops the prognosis is poor and associated with a high rate of perinatal mortality and severe respiratory insufficiency in the newborn. We report the case of a fetus presenting at 31 weeks with generalized hydrops, bilateral hydrothorax and a left pulmonary hyperechogenic mass, successfully treated by thoracoamniotic shunting using a catheter and amniodrainage. Serial ultrasound showed normal growth and normal amniotic fluid volume. The newborn did not require surgery and long-term outcome was normal. Based on this observation, the natural history of pulmonary sequestration and prenatal management options are reviewed and discussed.