TDx-FLM Test to Determine the Fetal Lung Maturity / 대한산부인과학회잡지

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (por=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.

TDx-FLM Test to Determine the Fetal Lung Maturity / 대한산부인과학회잡지

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (por=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.

Umbilical Nucleated Red Blood Cell Counts and Perinatal Outcome According to Doppler End-Diastolic Velocity in Severe Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: To assess the umbilical nucleated red blood cell counts and perinatal outcomes according to umbilical artery Doppler end diastolic velocity in severe preeclampsia. MATERIALS AND METHODS: A prospective case-control study comparing 42 severe preeclampsia patients who had present umbilical artery end diastolic velocity with 7 severe preeclampsia patients who absent end diastolic velocity for umbilical nucleated red blood cell counts and perinatal outcomes. RESULTS: Those with absent end diastolic velocity did not have significantly greater nucleated red blood cell counts, but they had increased hemoglobin, hematocrit. These newborn had significantly lower birth weight, increased Cesarean section rate for fetal distress and been more frequently admitted to the neonatal intensive care unit. These newborn also had significantly increased intracranial hemorrhage,assisted ventilation and longer hospital days. CONCLUSION: No correlation with nucleated red blood cell counts and chronic fetal hypoxia were presented. However further study with more expanded cases for the role of nucleated red blood cell counts as a marker of fetal hypoxia will be needed.

Twin Pregnancies: In Vitro Fertilization vs. Spontaneously Conceived / 대한산부인과학회잡지

OBJECTIVE: To compare the obstetrical and perinatal outcomes of twin pregnancies after IVF-ET with those of twin pregnancies conceived spontaneously. METHODS: Two hundred and six cases of IVF-ET twin pregnancies (IVF group) were compared with 229 spontaneously conceived or ovulation induced twin pregnancies (spontaneously conceived group) for obstetrical and perinatal outcomes. All were delivered between July 1994 and February 2002 at Ajou University Hospital. Their clinical records were reviwed. RESULTS: The mean maternal age of IVF group and spontaneously conceived group was 30.7+/-3.7 years, 28.4+/-4.0 years and primiparous women were 86.9%, 58.5% (p=0.000). In IVF group and spontaneously conceived group, mean gestational age was 35.0+/-1.7 weeks, 35.5+/-2.1 weeks (P=0.000), mean birth weight 2311.4+/-411.7 gm, 2324.3+/-447.1 gm (P=0.015), and frequency of birth weight less than 2500 gm 70.6%, 60.3% (p=0.001). In both groups, the frequencies for preterm labor, preeclampsia, intrauterine growth restriction, and birth weight discordancy were 42.2%, 32.3% (p=0.032), 8.3%, 18.3% (p=0.002), 5.3%, 8.7% (p=0.052%), 7.8%, 10.9% (p=0.262), respectively. On the comparison of the chorionicity, monochorion- diamnion was 2.0%, 36.3% (p=0.000) and dichorion-diamnion was 98.0%, 62.8% (p=0.000). And there was no significant difference in congenital anomaly, Apgar scores, frequency and duration of neonatal intensive care unit admission. CONCLUSION: In IVF-ET twin group compared with spontaneously conceived group, there was higher incidence of preterm labor, and low birth weight.

The Significance of Normal 100 gm Oral Glucose Tolerance Test on Perinatal Outcomes / 대한산부인과학회잡지

OBJECTIVE: To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. METHODS: We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. RESULTS: There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7+/-1.5 vs 38.5+/-1.5 weeks), birth weight (3189.2+/-420.9 vs 3236.7+/-423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. CONCLUSION: We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes.

A Novel Anti-apoptosis Gene, Survivin, Expressed in Uterine Cervical Carcinoma / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Survivin is a novel inhibitor of apoptosis. Suppression of apoptosis is important for carcinogenesis and tumor growth. The purpose of this study was to investigate whether survivin is expressed in the tissues of normal uterine cervix, cervical intraepithelial neoplasia grade III (CIN III) and squamous cell carsinoma of the uterine cervix, as a first step for evaluation of the clinical significance of survivin in uterine cervical cancer. METHODS: We investigated the expression of survivin in the tissues of 11 cases of normal uterine cervix and 14 cases of CIN III and 20 cases of uterine cervical cancer, using Immunohistochemistry at department of obstetrics and gynecology of Ajou university hospital from Jan. 2000 to Jan. 2001 and then compared with the results of three groups. RESULTS: The expression of survivin is increased significantly in cases of CIN III and uterine cervical cancer compared with controls. (p<0.05, One way ANOVA test) CONCLUSION: This study shows survivin could play an important role in the carcinogenesis mechanism of uterine cervix. And further study will be followed to evaluate the clinical relationship of survivin in uterine cervical cancer and whether to act a prognostic factor or not.

Perinatal outcomes in twin pregnancy with birth weight discordancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the perinatal outcomes of twin pregnancies with birth weight discordancy and to determine factors affecting on the outcomes. METHODS: We studied 367 pairs of twin delivered after 28 weeks of gestation at the Ajou University Hospital between June 1994 and June 2000. Twins were stratified into three groups according to the percent difference of birth weight. Birth weight difference less than 15%(concordant) was classified into control group(268 pairs), between 15% and 25% into group 1(72 pairs), and more than 25% into group 2(27 pairs). Perinatal outcomes of each group were assessed retrospectively. RESULTS: In smaller twins, mean birth weight(control vs group 1 vs. group 2 : 2274.3+/-424.9 gm vs. 2012.9+/-303.2 gm vs. 1635.2+/-440.8 gm, p<0.05), duration of neonatal intensive care unit admission(7.6+/-11.5 days vs. 11.6+/-10.8 days vs. 18.6+/-14.4 days, p<0.05), and the frequency of neonatal jaundice(8.6% vs. 12.5% vs. 29.6%, p<0.05), the frequency of small for gestational age infant(8.2% vs. 40.3% vs. 74.1%, p<0.05), and perinatal mortality(2.6% vs. 2.8% vs. 11.1%, p<0.05) in group 2 showed statistically significant difference from control group. No difference was found in larger twins. In multiple logistic regression analysis, independent prognostic factors of discordant twin were gestational age and birth weight. CONCLUSIONS: In twin pregnancies with birth weight discordancy, larger twins showed no difference in perinatal outcomes but smaller twins with birth weight discordancy more than 25% showed significantly higher perinatal mortality and morbidity. However independent prognostic factor was not discordancy itself but gestational age and birth weight.

Endometriosis is closely associated with endometrial polyps; The effectiveness of hysteroscopy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effectiveness of hysteroscopy and the incidence of endometrial polyps in women with endometriosis. METHODS: A total of 99 patients determined to be with infertility by laparoscopic procedure from March 1999 to February 2000 were prospectively analyzed at Ajou University Hospital, Suwon, Korea. The study group was 63 patients with endometriosis and the control group consisted of 36 patients without endometriosis. The presence of endometriosis was documented laparoscopically and scored according to The American Fertility Society Classification. We confirmed the presence of endometrial polyps by pathologic examination after polypectomy. We compared the results of the operation to that of the hysterosalpingogram(HSG) and transvaginal sonogram(TVS) before the procedure. RESULTS: Among the 99 patients with infertility, endometrial polyps were found in 40 of 63 women(63.5%) with endometriosis but in only 10 of 36 women(38.5%) without endometriosis. The greater the degree of endometriosis was accompanied by increased incidence of endometrial polyps, and in particular, women with stage three endomeriosis or higher all showed the presence of endometrial polyps. The sensitivity and specificity of the HSG detecting the presence of an endometrial polyp is 55.3%, 87.2%, and that of the TVS is 78.9%, 95.7%. DISCUSSION: The presence of endometrial polyps is significantly associated with the presence of endometriosis, and therefore hysteroscopy should be performed in patients with endometriosis who have not been confirmed with endometrial pathology by HSG or TVS.

Intrauterine Intussusception Presenting as Transient Fetal Ascites / 대한주산의학회잡지

No abstract available.

Clinical outcomes of pregnancy showing one abnormal glucose tolerance test value / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcomes of pregnancies showing one abnormal glucose tolerance test value. Method: We performed 50 gm glucose challenge test in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dL, 100 gm oral glucose tolerance tests (OGTTs) were performed at 28-32 weeks of gestation. In the 888 cases who were followed up, according to the National Diabetes Data Group (NDDG) criteria, 122 cases with one abnormal 100 gm OGTT value were divided into three groups (groups 1, 2, 3 : abnormal value after 1, 2, 3 hours, respectively). These were compared with 577 cases (control group) with normal 100 gm OGTT value, retrospectively. Result: The incidence of one abnormal glucose tolerance test value was 2.6%, and there were no cases where the fasting plasma glucose level only was elevated. The incidence (control, group 1, group 2, group 3 : 19.4%, 43.8%, 25.7%, 29.6%) of poor maternal outcomes which contain any one of preeclampsia, hydramnios, cesarean delivery for cephalopelvic disproportion or failure to progress or fetal distress was highest in group 1 (p=0.025). The incidence (15.8%, 43.1%, 14.3%, 21.1%) of poor perinatal outcomes which contain any one of fetal distress, Apgar score of 5 minute < 7, hypoglycemia, respiratory distress syndrome, small for gestational age, perinatal death was also highest in group 1 (p=0.009). Logistic regression analysis for poor maternal outcomes showed odds ratio of 2.83 (95% confidence interval 1.02-7.87) in group 1 and 2.08 (95% confidence interval 1.22-3.55) in group 3, and for poor perinatal outcomes odds ratio of 4.24 (95% confidence interval 1.02-17.52) in group 1 and 3.30 (95% confidence interval 1.45- 7.48) in group 3. CONCLUSION: Pregnancies complicated with one abnormal glucose tolerance test value, particularly the group showing abnormal glucose tolerance test value after 1 or 3 hour exhibited adverse maternal and perinatal outcomes.

The Clinical Significance of The Qualification of Atypical Squamous Cells of Undetermined Significance (ASCUS) in Cervicovaginal Smears / 대한산부인과학회잡지

OBJECTIVE: The Bethesda System (1991) recommended that the diagnosis of atypical squamous cells of undetermined significance (ASCUS) be qualified when possible to indicate whether a reactive process, or premalignant/malignant process, is favored. In order to evaluate the clinical significance of the qualification, we reviewed our hospital's experience with cervicovaginal smears diagnosed as ASCUS. METHOD: A retrospective study from June 1994 to December 2000 was performed on all cervicovaginal smears with the diagnosis of ASCUS. 3759 cases were included in study group. The 1200 cases of 3759 were not followed up. Histopathologic diagnosis and cervicovaginal smear results were reviewed and compared according to the qualification of ASCUS. The Chi-square test was used. RESULTS: Histopathologic diagnosis of low-grade squamous intraepithelial lesion (LGSIL) was seen in 46.1%, 47.8%, and 44.3% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. Histopathologic diagnosis of high-grade squamous intraepithelial lesion (HGSIL) was seen in 6.0%, 17.2% and 7.8% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. In ASCUS FR group, 1 invasive carcinoma was detected. In ASCUS FD group, 6 carcinoma in situ (CIS), 2 microinvasive carcinoma, 1 invasive carcinoma and 1 adenosquamous cell carcinoma were detected. In ASCUS NOS group, there were 20 CIS, 5 microinvasive carcinoma, 7 invasive carcinoma and 2 invasive adenocarcinoma. The ASCUS FD group demonstrated significant risk for SIL and more severe lesion but ASCUS FR and ASCUS NOS demonstrated no significant difference. CONCLUSION: ASCUS FD group has increased risk for detection of SIL or more severe lesion than ASCUS FR or ASCUS NOS group. But there were also significant number of SIL and even invasive cancer in ASCUS FR and ASCUS NOS group, so qualification of ASCUS was not useful for management and colposcopy-directed biopsy is advocated even in ASCUS FR group.

A Clinical Review of the HELLP Syndrome / 대한주산의학회잡지

No abstract available.

Primary non-Hodgkin's lymphoma of the vulva / 대한부인종양콜포스코피학회잡지

Malignant lymphomas of the female genital tract are rare. When it involves the female genital tract, information in the literature regarding the classification, treatment and diagnosis of malignant lymphoma are few. Non-Hodgkin lymphomas (NHL) of the female genital tract occurs primarily in the ovary (49%), uterus (11%), vagina (7%), and vulva (4%). The vulva as the primary location is a very rare occurrence. However, autopsy studies have shown that about 40% of women who die of non-Hodgkin's lymphoma had involvement of the uterus or ovaries. There have been many cases of high-stage lymphomas presenting as secondary involvement of the female genital tract, but when the primary involvement site is the vulva, the stage of lymphoma was most commonly stage IE or IIE. Therefore, physicians should keep in mind the possibility of the presence of a malignant neoplasm when the suspected Bartholin's gland tumor does not respond to treatment. The authors propose that thorough gynecological evaluation should be conducted as a routine screening method in female patients with suspected lymphoma. We represent a case of primary non-Hodgkin's lymphoma patient who was relatively young in age and who was consequently determined to be of a high stage.

Clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance and gestational diabetes mellitus / 대한산부인과학회잡지

OBJECTIVES: To evaluate the clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). METHODS: We performed 50gm oral glucose tolerance test (OGTT) for GIGT and GDM screening in 4,367 pregnant women at 24-28 weeks of gestation. In 1,010 women with plasma glucose level over 130mg/dl, 753 women underwent 100gm OGTTs at 28-32 weeks of gestation. According to the NDDG criteria, 113 cases with GIGT (single positive level of OGTT ; group 2), 125 cases with GDM (group 3), and 515 cases with control (group 1) were identified among the 753 cases. Retrospective review of outcome of these patients was performed. ANOVA and chi-square test were used to determine the statistical significance. RESULTS: The incidence of GIGT and GDM was 2.7%, 3.0%. The prepregnant body mass index (21.4+/- 3.0kg/m2, 21.3+/-2.8kg/m2, 23.2+/-4.1kg/m2), overweight of BMI over 26 (7.4%, 4.4%, 14.4%) and obesity of BMI over 30 (1.2%, 0.0%, 8.0%) was significantly higher in group 3 than group 1 (p<0.05). We defined poor maternal outcome as those suffering from any one of birth canal injury, hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, fetal distress. Group 3 showed most highest poor maternal outcome (22.3%, 28.3%, 39.2%, p<0.05). And we defined poor neonatal outcome as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome. Group 2 and group 3 showed poor neonatal outcome than group 1 (6.2%, 13.3%, 21.6%, p<0.05). CONCLUSION: Pregnancies complicated with GDM showed poor maternal and neonatal outcome, and GIGT experienced no adverse maternal outcomes but showed poor neonatal outcomes compared to normal pregnancy, and showed less correlation with obesity than GDM. Further study of pathophysiology and proper management of GIGT will be mandatory.

Clinical Characteristics of Two Types of Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The endometrial cancer can be divided into two large groups on the base of carcinogenesis according to the pathologic findings. The hormone induced cancer group(type 1) represents the cancers developed under the effects of unopposed estrogen. And the other group(type 2) can be developed by the mechanisms of divergent variable events such as mutations or gene deletions. These two different types show definite differences in clinical characteristics. METHODS: Clinical features of the 43 patients who were diagnosed and were treated as endometrial cancer in Gynecologic department of Ajou University Hospital from June 1994 to November 2000 were evaluated according to the pathologic findings. 22 patients of type 1 and 17 patients of type 2 were classified and analysed statistically. RESULTS: Age, cell types, grade, cancer stage, endometrial thickness, invasion depth of uterine walls were definitely different with statistic significance. The lymphovascular space invasion, the number of lymph node metastasis, pap smear of cervix, adnexal involvement, diabetes, hypertension, CA125, gravida, height were not different between two groups statistically in correlations. BMI shown marked difference but had no statistical significance. CONCLUSIONS: The classification of endometrial cancer into the two types is very significant because it can allow avoidance of preceding risk factors and can provide the alteration of treatment tendency and the expectation of benign or malignant prognosis, clinically.

Efficacy of Conization in Patients with Cervical Intraepithelial Neoplasia / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to evaluate the efficacy of conization of the cervix in patients with cervical intraepithelial neoplasia. STUDY DESIGN: Cold-Knife conization was performed in total 436 patients from June 1994 to May 2000. Indications and complications of conization were studied. And the results of cervical cytology, cervical histology, colposcopic findings and pathologic diagnosis of conization specimens were evaluated in comparison with the pathologic diagnosis of hysterectomy specimens and follow-up check of the patients. RESULTS: Followings are results summarized. 1. Patients distribution according to cone biopsy results was 31.0% for CIS, 43.3% for CIN III, 14.7% for CIN II, 7.6% of CIN I, 3.4% for CNI, respectively. 2. The rate of agreement between colposcopy-directed biopsy and conization was 63.1%. 3. The positive rate of resection margin was 15.1%. 4. The recurrence rate in clear resection margin group was 7.0%. But there was no recurrence after hysterectomy in cases with positive resection margin of conization specimen, and the recurrence rate of positive resection margin without hysterectomy group was 10.5%. 5. The incidence of delayed hemorrhage (bleeding after 2 weeks) in hemostatic suture group and electric cauterization only group was 4.7% (13/279) and 15.6% (23/157), respectively. CONCLUSION: We conclude that conization of the cervix as the surgical treatment was effective in CIN patients with careful patient selection.

A Case of Primary Choriocarcinoma of The Fallopian Tube / 대한부인종양콜포스코피학회잡지

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.

Clinical Manifestations and Perinatal Outcomes in Pregnancies with Fetal Dysplastic Kidney Disease / 대한산부인과학회잡지

OBJECTIVE: To obtain clinically useful data regarding prenatal diagnosis, proper antepartum counseling and obstetric management in pregnancies with fetal dysplastic kidney disease. METHODS: We retrospectively reviewed 13 cases of MCDK(Multicystic dysplastic kidney) and PCDK(Polycystic dysplastic kidney), diagnosed by antenatal ultrasound and delivered from June 1994 through July 1999 at Ajou University School of Medicine, Department of Obstetrics and Gynecology, with regard to prenatal ultrasonographic findings, perinatal outcomes, maternal complications and associated fetal anomalies. RESULTS: The incidence of MCDK and PCDK was one in 1,066 and one in 2,398 births, respectively. Of the 9 cases of MCDK, one case was terminated due to severely associated anomaly, and 6 cases were delivered by spontaneous labor or pitocin induction at term, of which 1 case was delivered by pitocin induction at 36 weeks gestation due to intrauterine fetal death. Two cases were delivered by cesarean section. There were no neonatal deaths in 7 cases of MCDK and they have been followed up to date, and alive. Of the 4 cases of PCDK, 3 cases were terminated by induced abortion or induced vaginal delivery, and 1 case was delivered by cesarean section, which was combined with hypertrophic cardiomyopathy, and the baby died within 24 hours after birth. Perinatal complications consisted of small for gestational age, urinary tract infection, hydronephrosis, acute respiratory failure, acute renal failure, periventricular hemorrhage and laryngomalacia in the neonatal period. CONCLUSION: It is suggested that antenatal ultrasonography and genetic analysis to evaluate accurate diagnosis and associated anomalies should be performed to manage and councel properly the pregnancies with fetal dysplastic kidney disease.

Expression pattern of progesterone receptor, integrinbeta(3), cyclooxygenase-2 ( COX-2 ) in human endometrium of patient with the disease related implantation / 대한산부인과학회잡지

OBJECTIVE: We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium. STUDY DESIGN: Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ~ 8 days after ovulation (POD 7 ~ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. RESULTS: PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. CONCLUSIONS: In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.

Postoperative adjuvant CCRT concurrentchemoradiotherapy for selected early stage cervical cancer patients following radical hysterectomy and pelvic lymph node dissection / 대한산부인과학회잡지

No abstract available.