Effect of anemia on disease free survival of cervical cancer patients treated with concurrent chemoradiotherapy / 대한산부인과학회지

OBJECTIVE: Many studies suggested the negative impact of anemia on cervical cancer patients who were treated with radiotherapy. However during the past several years, concurrent chemoradiotherapy was recognized as the standard therapy of locally advanced cervical cancer. The purpose of study was to evaluate the effect of anemia on disease free survival in cervical cancer patients with concurrent chemoradiotherapy. METHODS: 116 patients were selected, who were diagnosed as cervical cancer at Yonsei University Medical Center from October 1998 to June 2003 and treated with concurrent chemoradiotherapy. Medical record was retrospectively reviewed for patient characteristics, hemoglobin, hematocrit and disease free survival. Disease free survival was analysed by univariate analysis, multivariate analysis and Kaplan-Meier method. Patients with hemoglobin value under 10 g/dL, hematocrit value under 30% were considered anemic. RESULTS: After mean follow up duration of 27 months, among 116 patients, 26 patients experienced recurrence or progression and 10 of these patients died. Univariate and multivariate analysis reveals that stage (P=0.00, P=0.03), lesion size (P=0.01, P=0.01) and the 6th cycle hematocrit (P=0.01, P=0.01) were determinants of disease free survival. CONCLUSION: In cervical cancer patients treated with concurrent chemoradiotherapy, initial hemoglobin level was not related to the prognosis. However the higher stage, greater lesion size, and lower level of 6th cycle hematocrit were related to the poor prognosis.

The Relationship between Maximal Urethral Closure Pressure and Functional Urethral Length in Anterior Vaginal Wall Prolapse Patients According to Stage and Age

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Colposcopy Directed Cone Biopsy and Endocervical Curettage as Management of Carcinoma in Situ of the Uterine Cervix / 대한산부인과학회잡지

OBJECTIVE: The goal of this study was to evaluate the prognostic factors in relation with residual cervical intraepithelial neoplasia (CIN) in hysterectomized specimen of the patients diagnosed as carcinoma in situ of the uterine cervix (CIS) and underwent cone knife biopsies first. Also we investigated if colposcopically directed wide cone knife biopsy with endocervical curettage followed by electrocauterization could substitute for traditional hysterectomy as a conservative management of CIS. METHODS: Data were collected retrospectively from 169 patients who were diagnosed as CIS after colposcopy directed conization in Yonsei University Hospital from Jan 1997 to Dec 2001. The patients were divided into two groups, those who underwent colposcopically directed cone biopsy only (Group A) and those who received colposcopically directed cone biopsy and extrafascial abdominal hysterectomy (Group B). Pap smear, pelvic examination and punch biopsy of the uterine cervix according to symptoms and physical findings of the patients were performed for follow-up. Patient characteristics, histologic results and follow-up outcomes were compared using student t-test, x2 test, and logistic regression analysis. RESULTS: Among 169 patients, 82 (study group) received no further treatment while 87 (control group) were hysterectomized. 58 of control group showed residual CIN in colposcopically directed cone biopsy and 12 from these patients, residual CIN were found in hysterectomized specimen. Positive endocervical margin on conization was found as a significant predictor for residual disease after conization. Abnormal Pap smear results were reported in 10 patients of study group only, of whom 2 cases of CIN I, 8 cases cervicitis. CONCLUSION: The residual CIN in endocervical margin can predict whether hysterectomized specimen might contain residual CIN and no difference in life threatening prognosis existed between the patients received colposcopically directed cone biopsy only and hysteretomy, regardless of the residual CIN in cone biopsy margin. Based on these results, it is reasonable to choose expectant management over hysterectomy for treating CIS patients with marginal involvement.

Prenatal Ultrasonograpy of Cystic Hygroma in Unusual Site / 대한산부인과학회잡지

Among 2,055 cases of abnormal findings detected by prenatal ultrasonography at Yonsei University College of Medicine from January 1996 to June 2002, the incidence and the site of cystic hygroma were evaluated. The clinical courses and postnatal prognosis were studied in four cases with cystic hygroma developed in unusual sites. Among 2,055 cases of abnormal ultrasonographic findings, 76 cases (3.70%) were diagnosed as cystic hygroma. Among 76 cases of cystic hygroma, 4 cases (5.3%) were detected in unusual sites; 1 case in mediastinum, 1 right axillary area, and 2 in anterolateral portion of neck. In cystic hygroma, prenatal accurate ultrasonographic findings including size and site of mass are important. Cystic hygroma developed in unusual sites are associated with perinatal complications including airway obstruction and compression of the surrounding organs. In giant cystic hygroma, cesarean section should be considered to avoid trauma and birth injury. After delivery, close observation and proper management are required.