Diagnostic efficacy of saline infusion sonohysterography and hysteroscopy for intrauterine lesion / 대한산부인과학회지

OBJECTIVE: To compare the diagnostic accuracy and acceptability of saline infusion sonohysterography (SIS), and hysteroscopy for detecting intracavitary abnormalities in women with abnormal uterine bleeding. METHODS: Seventy-eight patients with abnormal uterine bleeding were selected from the Department of Obstetrics and Gynecology in Chonnam University Hospital. The findings at SIS were compared with the hysteroscopic and histologic findings. The agreement of diagnosis between SIS and hysteroscopy was calculated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: SIS had a sensitivity of 84% and a specificity of 85% for a diagnosis of endometrial polyp. Hysteroscopy had a sensitivity of 86% and a specificity of 96% for diagnosis of endometrial polyp. SIS had a sensitivity of 75% and a specificity of 86% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 99% for a diagnosis of submucosal myoma. SIS had a sensitivity of 91% and a specificity of 96% for a diagnosis of submucosal myoma. Hysteroscopy had a sensitivity of 100% and a specificity 91% for a diagnosis of endometrial hyperplasia. CONCLUSIONS: The diagnostic accuracy of SIS was significant to that of hysteroscopy in diagnosing intracavitary abnormalities, Moreover, SIS in a safe, convenient, cost effective, easily accessible and acceptable investigative modality.

Changes of interleukin-6, tumor necrosis factor-alpha, and total antioxidant ability in the umbilical venous plasma of preterm birth with or without premature rupture of membranes / 대한산부인과학회지

OBJECTIVE: To compare interleukin-6 (IL-6), tumor necrosis factor-alpha(TNF-alpha), oxygen-radical absorbance capacity (ORAC), and antioxidant vitamin levels in the umbilical venous plasma of preterm labor with intact membranes (PTL) and preterm premature rupture of membrane (PPROM) with that of full term normal pregnancy (NP) and to evaluate their roles of pathophysiology in preterm labor and PPROM. METHODS: Umbilical venous blood samples were collected from women with PTL (n=30), PPROM (n=30) and NP (n=30). IL-6 and TNF-alpha were measured by enzyme-linked immunosorbent assay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC was mesured by Cao's method. Antioxidant vitamin levels were measured by high performance liquid chromatography. RESULTS: IL-6 and TNF-alpha levels in the umbilical venous plasma of PPROM were significantly higher than that of PTL and NP (3.28+/-0.31 vs. 2.84+/-0.19 vs. 2.79+/-0.22 pg/ml, p<0.05), (2.30+/-0.27 vs. 1.64+/-0.23 vs. 1.40+/-0.25 pg/ml, p<0.01). Lipid peroxide levels in the umbilical venous plasma of PPROM were significantly higher than that of NP and PTL (2.78+/-0.27 vs. 2.54+/-0.32 vs. 2.24+/-0.24 nmol/mg protein, p<0.01). ORAC levels in the umbilical venous plasma of PTL and PPROM were significantly lower than that of NP (967425.4+/-98.99 vs. 965165.8+/-91.20 vs. 1011328.5+/-85.96 U/ml, p<0.05). Ascorbic acid levels in the umbilical venous plasma of PPROM were significantly lower than that of NP and PTL (125.6+/-2.33 vs. 158.3+/-3.08 vs. 221.7+/-2.82 nmol/ml, p<0.01). CONCLUSION: Increase in inflammatory cytokines (IL-6, TNF-alpha) and imbalance of increased lipid peroxidation and decreased antioxidant activity in umbilical venous blood may be involved in the pathophysiology of PPROM.

Interleukin-6, tumor necrosis factor-alpha, and antioxidant levels in the umbilical venous plasma of preeclampsia / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate Interleukin-6 (IL-6), tumor necrotic factor-alpha (TNF-alpha), lipid peroxide levels, oxygen-radical absorbance capacity (ORAC), and antioxidant levels in umbilical venous blood plasma and to evaluate the roles of them in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of umbilical venous plasma were obtained from 20 normal and 20 preeclamptic women between 33 and 40 weeks gestation. IL-6 and TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels were measured by thiobarbituric acid reaction. The ORAC values were measured by Cao's method. Ascorbic acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography. RESULTS: There was no significant differences of IL-6 levels in umbilical venous plasma between women with normal and preeclampsia (2.79+/-0.21 vs. 2.94+/-0.17 ng/ml). TNF-alpha levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with preeclampsia (3.04+/-0.01 vs. 1.40+/-0.01 ng/ml, p<0.01). Lipid peroxide levels in umbilical venous plasma of women with preeclampsia were significantly higher than that of women with normal pregnancy (7.32+/-0.09 vs. 5.18+/-0.14, p<0.01). The ORAC values in umbilical venous plasma of women with preeclampsia were significantly lower than that of women with normal pregnancy (12,836.5+/-249.4 vs. 10,490.2+/-276.9 U/ml, p<0.05). Ascorbic acid levels in umbilical venous plasma of women with preeclampsia were significantly lower than those of women with normal pregnancy (320.2+/-48.5 vs. 538.5+/-68.2 nmol/ml, p<0.05). CONCLUSION: The above results in umbilical venous plasma suggest that the imbalance of lipid peroxidation and antioxidant activity in placenta is involved in the pathophysiology of preeclampsia. Increased TNF-alpha in the umbilical venous plasma showed inflammatory reaction in the placenta would be one of the cause of preclampsia. An antioxidant vitamin, ascorbic acid, may act an important antioxidant factor in preeclampsia.

A Case of Papillary Carcinoma of Thyroid Gland Arising from Ovarian Mature Cystic Teratoma / 대한산부인과학회잡지

Malignant transformation is a rare complication in a mature cystic teratoma of the ovary, usually being reported less than 2% of cases. The most common malignant tumor arising from a mature cystic teratoma of the ovary is a squamous cell carcinoma. However, adenocarcinoma is reported extremely rare, in most cases it was impossible to tell the source of the malignancy. We experienced a case of papillary carcinoma of thyroid glands arising from mature cystic teratoma of the ovary and report this case with a brief review of literature.

Comparison of Two Dose Regimens of Misoprostol for Cervical Ripening and Labor Induction / 대한산부인과학회잡지

OBJECTIVE: To compare the safety and efficacy of two dose regimens of intravaginally administered misoprostol (PGE1) for cervical ripening and labor induction. METHODS: One hundred patients with unfavorable cervix (including PROM) for labor induction were randomly assigned to group A and group B. Group A patients received 25 g of vaginal misoprostol every 4 hours with maximum of 6 doses and group B patients received 25 g, 50 g, 100 g, 100 g of misoprostol every 4 hours with maximum of 4 doses. Misoprostol was inserted to the posterior vaginal fornix. Successful induction was defined when Bishop score was increased to greater than 9 or regular uterine contractions were developed. The rates of successful induction, vaginal delivery, mean time from induction to delivery, drug side effects, and neonatal outcomes were compared. RESULTS: The average interval from start of induction to vaginal delivery was shorter in group B (780.1+/-313.0 minutes) than group A (1108.9+/-485.9 minutes) (p<0.01). The rate of vaginal delivery was higher in group B (42/50, 84.0%) than group A (35/50, 70.0%) although statistically not significant. The incidences of tachysystole, abnormal fetal heart rate tracing, meconium passage, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit were not different between two groups. CONCLUSIONS: Induction with misoprostol using dose-increasing schedule showed shorter time from induction to delivery and higher rate of successful induction than using same dose schedule without increase of side effects and adverse neonatal outcomes.

Nitric Oxide Concentrations in the Uterine, Umbilical, and Peripheral Venous Plasma of Women with Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to measure circulating levels of nitric oxide metabolites (nitrites) in the uteroplacental, fetoplacental, and peripheral circulation in women with normal pregnancy and preeclampsia. METHODS: Two groups of pregnant women were included : 20 patients with preeclampsia and 18 normotensive women. At cesarean, blood samples were taken from the antecubital vein and uterine vein draining the placental site before delivery of the baby, and the umbilical vein after delivery of the baby. Plasma nitric oxide concentrations were determined with the Griess reaction by measuring combined oxidation products of nitric oxide, plasma nitrite and nitrate after reduction with nitrate reductase. RESULTS: Significantly higher serum nitrite concentrations were found in umbilical (46.53+/-22.01 vs. 17.51+/-7.43 M/L, p<0.05), uterine (51.78+/-14.19 vs. 21.23+/-11.6 M/L, p<0.05) and antecubital (66.41+/-20.87 vs. 21.26+/-9.54 M/L, p<0.05) venous plasma in the preeclamptic group compared with the control group. CONCLUSION: We observe higher levels of nitirc oxide metabolites in the uteroplacental, fetoplacental, and peripheral circulation in women with preeclampsia than in normal pregnancy. These results support the hypothesis that increased nitric oxide production may be a compensatory response to improve blood flow and offset the pathologic effects of preeclampsia.

Lipid Peroxide Levels and Total Peroxyl Radical-Trapping Ability in the Placenta of Women with Normal Pregnancy and Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate lipid peroxide levels, total peroxyl radical-trapping antioxidative parameter (TRAP) values, and antioxidant vitamin levels in placental tissues of women with preeclampsia and to evaluate their roles in the pathophysiology of preeclampsia. STUDY DESIGN: Samples of placental tissue homogenates were obtained from 23 normal and 18 preeclamptic women between 33 and 40 weeks gestation. TNF-alpha was assayed by an enzyme-linked immunoassay. Lipid peroxide levels measured by thiobarbituric acid reaction. The TRAP values were measured by modified Wayners method. Ascorbic acid, uric acid, retinol, alpha-tocopherol, and gamma-tocopherol were measured by high performance liquid chromatography (HPLC) CoulArray detector. RESULTS: TNF-alpha levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (21.4+/-3.39 vs. 10.3+/-1.06 pg/ml, p<0.05). Lipid peroxide levels in placental tissue homogenates of women with preeclampsia were significantly higher than that of women with preeclampsia (6.65+/-0.57 vs. 4.98+/-0.37 nmol/mg protein, p<0.05). TRAP values in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (0.24+/-0.02 vs. 0.31+/-0.03 mM, p<0.05). Ascorbic acid levels in placental tissue homogenates of women with preeclampsia were significantly lower than that of women with normal pregnancy (217.0+/-21.0 vs. 333.3+/-32.8 nmol/ml, p<0.05). CONCLUSION: The above results suggest that increased oxidative stress in placenta is involved in the pathophysiology of preeclampsia and ascorbic acid may act as an important preventive factor in the development of preeclampsia.

Comparsion of Laparoscopic with minilaparotomic myomectomy in uterine myoma / 대한산부인과학회잡지

OBJECTIVE: This study investigates the safety and effectiveness of laparoscopic myomectomy by comparing with minilaparotomic myomectomy in terms of the operation time, hemorrhage, pain, complications and pregnancy rates after operation. METHOD: Total 56 patients who underwent myomectomy in Chonnam National University Hospital from January 1996 to December 2000 were included. 26 subjects underwent minilaparotomy and 30 subjects laparoscopic myomectomy respectively. The number, size and place of uterine myoma, the operation time required, hemoglobin reduction, and operation indication were compared. The frequency of analgesics application, the period without analgesics injection, complications, and pregnancy rates after operation were investigated. RESULTS: 1. The amount of hemorrhage and hemoglobin markedly decreased in laparoscopic myomectomy in comparison with minilaparotomy (P<0.01). 2. Analgesics were much less frequently used in laparoscopic myomectomy than minilaparotomy (P<0.01). Also Analgesics were injected for a significantly shorter period after laparoscopic myomectomy (P<0.01). 3. There was no significant difference in operation time, hospital period and complications rates between two groups. 4. Total 24 patients conceived after myomectomy. 12 of them belonged to minilaparotomy patients group and 13 patients to laparoscopic myomectomy group. 10 patients of the former and 11 of the latter were delivered of a baby through elective cesarean section and there was no significant difference. One to each group tried vaginal delivery, and there was no complication such as uterine rupture. CONCLUSION: Laparoscopic myomectomy is a safe and effective to treat uterine myoma and better than minilaparotomy in terms of post operative pain and hemoglobin.

The Comparison of Conventional Pap Smear with ThinPrep Pap Smear in detecting HSIL and Cervix cancer / 대한산부인과학회잡지

OBJECTIVE: To compare the conventional Pap smear with the ThinPrep Pap smear in detecting HSIL and invasive cervical cancer and to determine the clinical value of ThinPrep Pap smear. METHODS : We evaluated the Pap smear results of 2933 patients. These subjects were selected from women having visited the early cancer clinic of the department of Obstetrics and Gynecology, Chonnam University Hospital, from Jan. 1998 to Dec. 2000. Of 2933 patients, conventional Pap smear and ThinPrep Pap smear were performed in 1594 and 1339 cases respectively. According to the results, sensitivity, specificity, positive predictability and negative predictability of both tests were compared and analyzed. RESULTS: In detecting HSIL and invasive cervical cancer, the conventional Pap smear examinations showed sensitivity 62.0%, specificity 96.5%, positive predictability 87.7%, and negative predictability 86.3%, while ThinPrep Pap smear did sensitivity 85.1%, specificity 98.3%, positive predictability 97.4% and negative predictability 89.7%. CONCLUSION: ThinPrep Pap smear makes it possible to obtain better specimen by reducing probable mistakes in sampling, and which can result in decreasing the rate of false negativity of Pap smear and increasing the accuracy of the Pap smear examination. Therefore, ThinPrep pap smear is a useful method in raising detection rate of HSIL and invasive cervical cancer.