A Significance of Thrombocytosis as a Prognostic Factor in Patient with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: We tried to determine the relevance of thrombocytosis as a possible prognostic factor in patient with epithelial ovarian cancer. METHODS: One hundred and eighty-three (183) patients with epithelial ovarian cancer had been surgically treated in our hospital between January 1984 and December 2001. Uni- and multivariate analyses were performed of 9 clinical variables including age, FIGO stage, histologic subtype, grade, volume of residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor marker (CA 125). The Kaplan-Meier method and log-rank test were used for univariate analysis and a multiple regression analysis based on the Cox proportional hazards model was done to find the independent prognostic variables. RESULTS: Prevalence of thrombocytosis was 20.8% and significantly correlated with FIGO stage (p=0.015), tumor grade (p=0.029), presence of ascites (p=0.001) and volume of residual tumor (p=0.032). Significant difference in survival between patients with or without thrombocytosis was found (p=0.006). Multivariate analysis model was used and only volume of residual tumor (p=0.004) was significant independent prognostic variable. Thrombocytosis (p=0.041) was significant independent prognostic variable in patients with early FIGO stage of disease. CONCLUSION: Thrombocytosis is a useful prognostic factor in epithelial ovarian cancer and significantly independent prognostic factor in patients with early FIGO stage of disease.

Statistical Analysis of Twin Pregnancy for 10 Years (1993~2002) / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the clinical aspects of twin pregnancy and its outcome. METHODS: From January 1993 to December 2002, we reviewed the medical records of 249 cases of twin birth at least weighed 500 g or more and over 20 weeks of gestation among 14,273 deliveries at Hanyang University Hospital. Paired sample t test and linear regression test were used for statistical analysis. p<0.05 was defined significantly. RESULTS: The incidence of twin births was one in 59.6 birth, and the annual rate of twin births has increased since last 10 years (p<0.05). The predominant age group was 25-29 (47.0%) and mean age was 29.8 +/- 3.9 years old. According to parity, primipara (63.9%) was the most frequent. The predominant gestational age of twin births was 37-38 weeks (42.2%) and mean gestational weeks of twin births was 36.3 +/- 2.9 weeks. The ratio of spontaneous and iatrogenic twinning were 73.1% vs 26.9%. The cephalic-cephalic combination (49.8%) was the predominant presentation. The most common mode of twin delivery was cesarean section (76.5%) and its main indication was "elective" (33.5%). The mean interval between 1st and 2nd baby deliveries among normal spontaneous vaginal delivery was 6 minute 28 seconds. Both male group (43.0%) was predominant. The mean birth weights of 1st and 2nd baby were 2341 +/- 592 grams and 2200 +/- 594 grams respectively. No significant differences were seen in one minute and five minute Apgar scores between 1st and 2nd baby. The most common type of placental membrane was single placenta, two chorion, two amnion (40.6%). The most frequent maternal complication during pregnancy was anemia (41.8%), followed by preterm labor (39.0%) and preeclampsia (20.9%). The perinatal mortality rate was 50 per 1000 newborns and 2 cases (0.8%) of maternal death were encountered. The risk of intrauterine fetal death and abortion was 2.4% and 0.8% respectively. CONCLUSION: Recently, although the incidence of twin pregnancy has been increased, it has greater risks of obstetrical complications and higher perinatal mortality than singleton pregnancy. Therefore, further prospective studies of twin pregnancy are needed for counselling and effective management about perinatal prognosis.

The Approximate Entropy in Maternal Anemia during Pregnancy according to Gestational Age / 대한주산의학회잡지

OBJECTIVES: Maternal anemia is common hematologic disorders during pregnancy. Although mild maternal anemia is not associated with fetal anemia, neonatal morbidity including fetal anemia are common with severe maternal anemia during pregnancies. We aim to analyze each variable of FHR using linear and nonlinear methods to detect maternal anemia during pregnancies. METHODS: Seventy antepartal anemic pregnant women(Hb<10.0g/dL) and the contrast group, 70 normal pregnant women were selected among the women who underwent nonstress test(NST) during 3rd trimester in Hanyang University Hospital. The calculated FHR parameters(NST time=20 min) from collected FHR data(40-50min) were made by HYFM II data file. To assess the difference between the anemic and normal pregnancy group, the parameters such as baseline FHR, variability (AMP, MMR), acceleration and deceleration(15bpm-15seconds), gestational age at the time of NST, loss of record, the number of fetal movement, FHR were evaluated. We compared the canonical correlation between each groups using variables of NST. The overall complexity of each FHR time series was quantified by its approximate entropy(ApEn), measure of regularity derived from nonlinear dynamics, "chaos theory". Finally we extract the value of ApEn and were compared between two groups, normal and anemic pregnant women. RESULTS: There were significant decrease of FHR variability(amplitude and mean minute interval) in anemic group. Canonical correlation ensemble was significantly high in 36th-37th and 38th-39th gestational weeks in anemic group(p-value=0.03048 and 0.03421). The value of ApEn was significantly low(0.68+0.26) in anemic group comparing with normal pregnant group(0.95+0.08), respectively. CONCLUSIONS: This study shows that FHR of maternal anemia is different from that of normal pregnant women, and that subtle behavioral differences could be demonstrated in uterus using computerized FHR analysis. The anemic women during pregnancy have more linear and less complicated FHR than the normal pregnancy group. ApEn, which is bound to be used as an index of fetal well-being would be used as an evaluating tool of intrauterine fetal function in the near future.

A Case of Acute Monoblastic Leukemia developed during Pregnancy / 대한주산의학회잡지

Acute leukemias are among the most common malignant neoplasms of young woman, but paradoxically, their incidence complicating pregnancy is cited to be very low. In most situations, the course of the pregnancy does not seem to be affected by the presence of the leukemia. So early diagnosis and treatment of acute leukemia might be very important., since acute leukemia in a pregnant young woman poses an immediate threat to life and any treatment delay would significantly worsen the patient's prognosis. We report a 37-year-old female who had symptoms and signs of acute leukemia such as vaginal spotting and leukemia cutis and was diagnosed as acute monoblastic leukemia M5(FAB) in January 2002 with 25 weeks' pregnancy. This case represents the use of combination chemotherapy successfully resulted in complete remission in the second trimester without any adverse impact on the fetus in uterus.

A Clinical Significance of Second-look Laparotomy in Patients with Epithelial Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate pathological complete remission rate (pCR), survival rate, recurrence rate, 91 patients who had clinical complete remission with epithelial ovarian cancer were studied. METHODS: From 1983 to 2002, 91 consecutive patients with epithelial ovarian cancer underwent surgical cytoreduction followed by platinum-based chemotherapy at the Department of Obstetrics and Gynecology, Hanyang University Hospital. At the conclusion of chemotherapy, all patients who were clinically disease free and whose CA 125 was 2 cm with advanced stage at primary surgery and negative second-look findings should be the focus of future protocols for consolidation chemotherapy.