Risk Factors Associated with Premalignant and Malignant Endometrial Polyps / 대한폐경학회지

OBJECTIVES: The objective of this study is to evaluate the prevalence of endometrial premalignant and malignant polyps in women who underwent hysteroscopic polypectomies, and to investigate whether clinical parameters predict histopathologic outcomes. METHODS: A review was carried out on the medical records of patients who had undergone hysteroscopic endometrial polypectomy from January 2010 to December 2011. One thousand one hundred ninety-six women who ranged in age from 16 to 81 years were included in the study. Polyps were classified as benign (endometrial polyps and polyps with non-atypical simple hyperplasia and non-atypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), or malignant. A statistical analysis was then performed. RESULTS: Histopathologically, 96.7% benign, 1.1% premalignant, and 2.2% malignant lesions were detected. Abnormal uterine bleeding and postmenopause were the only factors which were determined to be associated with a higher risk of malignancy, with an odds ratios of 5.07 (95% CI, 2.25-11.41) and 3.41 (95% CI, 1.14-10.24), respectively. CONCLUSION: The risk factors associated with premalignant and malignant endometrial polyps include abnormal uterine bleeding and menopause.

A Clinical Analysis of Patients with Premature Ovarian Failure: Compliance with Hormonal Treatment / 대한폐경학회지

OBJECTIVES: To analyze the clinical features of premature ovarian failure (POF) and patients' compliance with hormonal treatment. METHODS: A retrospective analysis of 126 patients diagnosed with POF was selected between January 2004 and December 2007. The clinical, etiologic features and treatment compliance were evaluated. RESULTS: The mean age of diagnosis was 33.2 +/- 5.2 years. The mean value of follicle stimulating hormone was 78.8 +/- 28.8 IU/L. The most common symptom was amenorrhea or oligomenorrhea (54%). Eighty-eight patients were married and 22 of them visited our clinic due to infertility. The most common etiology was unknown (54.8%) and the second most common cause was iatrogenic (29.4%). Only 61 patients underwent hormonal treatment (48.4%). The remaining 11 patients did not undergo hormonal treatment due to other medical conditions such as breast cancer or liver disease; however, they were followed-up regularly (8.7%). Among the treatment group, only 37 patients were followed-up over a period of 12 months (60.7%). CONCLUSION: About half of the women diagnosed with POF did not accept their own problems and therefore delayed essential treatment. Clinicians should educate the importance of early treatment for preventing degenerative changes.

Submucosal adenomyotic cyst successfully treated with hysteroscopic surgery: Two case reports / 대한산부인과학회지

Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Clinicopathological observation on ovarian masses in childhood and adolescence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.

Clinicopathological observation on ovarian masses in childhood and adolescence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. METHODS:We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. RESULTS: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). CONCLUSION: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.

A case of telangiectasis of the uterus: uncontrolled massive uterine bleeding after gnrh agonist therapy / 대한산부인과학회지

Telangiectasis of the uterus is an extremely rare but life-threatening disease because of massive uterine bleeding. The usage of GnRH agonist can cause regression and atrophy of the endometrium through induction of hypoestrogenism by pituitary down-regulation. But there is no clear explanation or report in the literature showing the relationship between uterine telangiectasis and GnRH agonist usage. We have experienced a patient with uncontrolled massive uterine bleeding after GnRH agonist treatment, who needed emergency hysterectomy. Pathologic tissue examination showed telangiectasis of the endometrium and myometrium. This is the first case report of telagiectasis of the uterus without other organ involvement. We report this case with a brief review of the literatures.

Ovarian hemangioma: A case report / 대한산부인과학회지

Hemangiomas of ovary are extremely rare tumors, although ovaries have a very rich vasculature. There are only approximately 50 cases of ovarian hemangioma reported in the literature. The most of ovarian hemangiomas are the cavernous type and may present either as isolated unilateral ovarian masses, which are discovered incidentally, or together with diffuse abdominopelvic hemangiomatosis. We report a case of a ovarian hemangioma discovered incidentally in a 35-year-old woman with brief review on this topic.

Uterine myoma: Treatment modalities and patient preference / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. METHODS: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients' characteristics, treatment methods and questionnaires for patient preference were evaluated. RESULTS: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. CONCLUSIONS: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.

Three different approach to hysterectomy for benign uterine pathology / 대한산부인과학회지

OBJECTIVE: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). METHODS: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. RESULTS: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2+/-27.1 min, 94.2+/-25.2 min, and 50.8+/-15.5 min, respectively), change in hemoglobin (2.3+/-1.5 g/dL, 2.0+/-0.9 g/dL, and 1.3+/-1.1 g/dL, respectively), duration of urinary catheterization (2.0+/-0.2 days, 1.0+/-0.0 days, and 1.0+/-0.4 days, respectively), postoperative hospitalization (5.7+/-1.2 days, 4.7+/-0.9 days, and 4.3+/-1.0 days, respectively), uterine weight (733+/-665 g, 340+/-213 g, and 300+/-156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). CONCLUSIONS: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.

Comparison of efficacy of GnRH agonist and intravenous iron therapy for preoperative correction of anemia in gynecologic patients / 대한산부인과학회지

OBJECTIVE: This study is aimed to compare the efficacy of GnRH agonist and intravenous iron therapy in women who need correction of anemia prior to hysterectomy for uterine myoma and adenomyosis. METHODS: We reviewed retrospectively the data of 105 patients with initial hemoglobin level under 10g/dl, who had undergone total abdominal hysterectomy after correction of anemia with GnRH agonist (Group 1) or intravenous iron therapy (Group 2) from January 2004 to April 2006. RESULTS: Initial hemogloblin level was not different between the two groups. After administration, hemoglobin level increased by 3.9+/-2.3 g/dl and 2.6+/-1.7 g/dl, respectively. Therefore, group 1 was superior in anemia correction (p<0.01). On postoperative 1st day, hemoglobin level was 10.3+/-1.6 g/dl and 9.0+/-1.0 g/dl. Correction duration was 7.8+/-4.7weeks (1-18weeks) in group 1 and 4.0+/-4.8weeks (1-30 weeks) in group 2. Shorter duration was needed for correction in group 2 (p<0.01). Surgically removed uterine weight was 391.4+/-195.1 gm and 630.6+/-648.9 gm, respectively. Uterine weight was heavier in Group 2 (p<0.01). CONCLUSION: In comparison of efficacy of GnRH agonist with intravenous iron therapy for the correction of preoperative anemia, corrected hemoglobin level was higher and removed uterine weight was smaller in group 1. But duration of therapy for the correction of anemia was shorter and cost-effectiveness was superior in group 2. Clinicians should consider the patients' condition prior to the selection of drug for preoperative anemia correction.

The rate of malignant endometrial polyps and it's associated factors / 대한산부인과학회지

OBJECTIVE: To determine the incidence of benign, hyperplastic, and malignant endometrial polyps and whether particular clinical parameters are associated with malignancy in the polyps. METHODS: Four hundred and forty nine patients who were suspected as endometrial polyps by hysteroscopy underwent hysteroscopic guided removal over 12 months period were retrieved. The medical records and histopathological findings were reviewed. Statistical analysis was performed. RESULTS: Histologically, among 360 (80.1%) polypoid lesions, 353 polyps (75.1%) were benign; 16 polyps (3.5%) had simple or complex hyperplasia, only 1 polyp (0.2%) had hyperplasia with atypia (considered as premalignant lesions), and 6 polyps (1.3%) were cancerous. Non polypoid lesions were found in 89 (19.9%) cases. Older age, postmenopausal status were associated with pre-malignant or malignant changes significantly, but presence of abnormal uterine bleeding, multiplicity, larger sizes (>1.5cm) were not a predictor of malignancy in the polyp. CONCLUSIONS: Age and menopausal status may increase the risk of premalignant and malignant polyps. Although the risk of malignancy is low, we should pay attention to postmenopausal women with endometrial polyps regardless of the symptoms, and we prefer hysteroscopic resection for the exact diagnosis.

Impact of vaginal hysterectomy on total vaginal length / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the impact of vaginal hysterectomy on total vaginal length (TVL). METHODS: Retrospective analysis of 155 medical records of patients underwent vaginal hysterectomy by one surgeon with benign uterine pathology in the absence of prolapse between January 2004 and February 2007. After hysterectomy, uterosacral vaginal vault resuspension (anchoring to vaginal vault about 1.0~1.5 cm proximal at the ligament) was performed for prevention of vault prolapse. Patients' characteristics and TVL before and after surgery were evaluated. RESULTS: Preoperative mean TVL was 7.32+/-0.84cm. At two months after the surgery, mean TVL was 7.42+/-0.77 cm. The change of vaginal length was statistical significance (P=0.045). Eighty-one patients were reevaluated at five to twelve months after surgery, mean TVL was longer than the preoperative results (7.3+/-0.82 cm vs 7.48+/-0.78 cm, P=0.011). We evaluated 30 patients who were followed at least 12 months after the surgery, the length was longer than the preoperative results, also (7.17+/-0.81 cm vs 7.46+/-0.66 cm, P=0.006). CONCLUSION: Although that appears to be statistically significant elongation of the total vaginal length after vaginal hysterectomy, the impact is unlikely to be clinically significant.

Clinical Usefulness of Transvaginal sonography and sonohysterography in evaluation of endometrial abnormalities / 대한산부인과학회지

OBJECTIVE: The aim of our study is to evaluate the clinical usefulness of transvaginal sonography (TVS) and saline infusion sonohysterography (SHG) in the evaluation of endometrial abnormality. METHODS: We retrospectively reviewed 370 patients with abnormal uterine bleeding or uterine cavity abnormalities confirmed by TVS. SHG was carried out by experienced gynecologist, on the same setting in an outpatient clinic after the performance of TVS. Two hundred nineteen patients aged between 23 and 69 years (mean age 41+/-8.2) had operative hysteroscopy (88.2%), hysterectomy (9.1%) and dilatation/curettage (2.7%) within 3 months which provided a detailed description of uterine cavity. Surgical-pathologic findings were compared with the results obtained from TVS and SHG. RESULTS: The sensitivity and specificity were 71.7% and 31.4% for TVS, and 98.4% and 67.6% for SHG respectively. The positive and negative predictive values were 84.6% and 17.5% for TVS, and 94.3% and 92.3% for SHG, respectively. Twenty one cases showed a discrepancy between the TVS and SHG, and 16 cases showed a discrepancy between SHG and the pathologic diagnosis. Fifty five cases (25%) in TVS were unconfirmed, but SHG showed 51 pathologic confirmed intracavitary lesion. CONCLUSION: SHG is a sensitive tool and is superior to TVS used alone for evaluation of endometrial abnormalities. SHG definitely enhances the diagnostic potential of TVS in assessment of endometrium and intracavitary pathologies.

Hysterectomy; Is it essential for the correction of uterine prolapse? / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. METHODS: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). RESULTS: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5+/-33.4 min, 2.4+/-0.7 mg/dL, 5.2+/-1.4 days, 7.6+/-2.2 days vs. Group B 135.3+/-33.9 min, 2.9+/-0.8 mg/dL, 6.1+/-2.1 days, 9.4+/-3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. CONCLUSIONS: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.

Mucinous Borderline tumor associated with Mature Cystic Teratoma of Ovary / 부인종양

OBJECTIVE: To evaluate the clinicopathological characteristics of mucinous borderline tumor associated with mature cystic teratoma and the origin of its cell type. METHODS: Five patients who were diagnosed as mucinous borderline tumor associated with mature cystic teratoma and treated in Samsung Cheil Hospital from January 1996 to September 2004 were analyzed. In addition MEDLINE, other data bases in English as well as in Korean revealed two more cases. We analyzed the result with patient's characteristics, preoperative symptoms, mass sizes, serum CA-125, operative procedure, stages, recurrence and survival period. Histological slides of the specimens were analysed for expression of cytokeratin (CK)-7 and cytokeratin (CK)-20 by immunohistochemical staining to know the origin of the cell. RESULTS: The mean age was 45 years (25-61 years). Preoperative symptoms were palpable abdominal mass, abdominal pain and urinary frequency. The mean level of CA-125 was 46.05 U/mL and the mean tumor size was 16.75 cm (8.8-22.0 cm). Post surgical FIGO staging was; stage Ia in 6 cases, stage Ic in 1 case. Four cases were CK7(-)/CK20(+), reflecting gastrointestinal origin, and also showed pattern of pseudomyxoma peritoneii. Mean survival period was 32.7 months (6-67 months) without evidence of recurrence, except one case. CONCLUSION: Our findings suggest that mucinous borderline tumor associated with mature cystic teratoma, is diagnosed at relatively young age and early stage, associated with good prognosis.

Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus / 대한산부인과학회지

OBJECTIVE: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. METHODS: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. RESULTS: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. CONCLUSION: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.

Carcinoma in situ of the uterine cervix in pregnancy / 부인종양

OBJECTIVE: The purpose of this study was to determine whether carcinoma in situ (CIS) of the uterine cervix in pregnancy alters in the postpartum period and to evaluate the factors associated with this alteration. METHODS: In this retrospective study, we found 30 pregnant women with CIS of the uterine cervix between 1999 and 2003. All women had the diagnosis of CIS made on cervical biopsy performed during pregnancy at Samsung Cheil Hospital. All pathologic reports of initial cytology and biopsy were reviewed and compared to the same evaluations postpartum. Postpartum alteration of CIS was analyzed with respect to the mode of delivery, gravidity and parity. RESULTS: The incidence of CIS in pregnancy was 0.6 per 1000 pregnancies (30/44,807) in this study. The mean age was 31.2 years (20-40), the mean gravidity was 2.7 (1-6) and the mean parity was 0.3 (0-2). The prenatal cytology that initiated the referral to our colposcopy center was commonly discordant with the histologic diagnosis of CIS. Five (16.7%) had cytology of ASCUS, 3 (10.0%) had LSIL, and 22 (73.3%) had HSIL. The overall postpartum persistence and regression rates of CIS were 73.3% and 26.7% respectively. No lesion progressed to invasive carcinoma. There was no statistically difference in regression or persistence rates according to the delivery mode, gravidity and parity. CONCLUSION: According to the result of this study, postpartum persistence rate of CIS was high but progression rate was low. The mode of delivery, gravidity and parity did not influence the regression or persistence rates of CIS in pregnancy.

Safety and Efficacy of Transvaginal Sacrospinous Colpopexy / 대한산부인과학회지

OBJECTIVE: To determine the success rate and complications of transvaginal sacrospinous colpopexy for symptomatic uterine/vault prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 105 women with a symptomatic uterine/vault prolapse were treated with transvaginal sacrospinous ligament colpopexy at samsung cheil hospital. Primary outcome measures were complications (acute and long term) and success rate, with failure defined as any degree of uterine/vault prolapse requiring repeat operation, any degree of symptomatic isolated uterine/vault prolapse, any pelvic organ prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive technique. RESULTS: During the study period, 105 transvaginal sacrospinous ligament colpopexy were performed: 41 with vaginal hysterectomy, 38 without hysterectomy, 25 for post-hysterectomy vault prolapse and 1 cervical amputation. The mean duration of follow-up was 17.7 months (0-66) There were no acute hemorrhage and no deaths. There were four intraoperative complications - three rectal wall injury and one bladder wall injury. There was a complaints of postoperative right buttock pain in 8 of the 105 procedure (7.6%), with this persisting on a chronic basis in 2 patients (1.9%). Postoperatively, there were 11 patients with uterine/valut prolapse, 4 with a cystocele and 1 with a rectocele. Of these 105, there were 6 failures (5.7%). CONCLUSION: Transvaginal sacrospinous colpopexy for the correction of uterine/vault prolapse, when performed by a surgeon experienced in the procedure, is safe and effective surgical procedure and rare major complications.