The Effect of intraperitoneal instillation of Mistletoe extract during the diagnostic laparoscopy for pain of endometriosis / 대한산부인과학회지

OBJECTIVE: Immune alternation is related to the pathogenesis and progression of endometriosis. Helixor-A, mistletoe extract, has been known that it has immune modulation effect. Therefore the purpose of this study is to determine the effects of Helixor-A for pain of endometriosis by intraperitoneal instillation of mistletoe extract during the diagnostic laparoscopy. METHODS: Among the paitients who visited to outpatient clinic due to chronic pelvic pain, 30 patients who had laparoscopically-confirmed endometriosis were included in this study. Helixor-A 5 mg was instilled into the posterior cul-de-sac during the diagnostic laparoscopy. Before diagnostic laparoscopy and one month after laparoscopy, the patients recorded pain scores. RESULTS: In 11 of 30 patients (36.7%), pelvic pain of endometriosis improved after laparoscopy. In 2 of 30 patients, the side-effect of Helixor- A appeared and they were easily controlled by antihistamines. CONCLUSION: The instillation of Helixor-A during diagnostic laparoscopy, that is essential for confirmation of endometriosis, may be helpful as a supportive treatment for treatment of pelvic pain due to endometriosis with classical treatment such as GnRH agonist therapy.

A Clinical Study on Malignant Germ Cell Tumor of Ovary / 대한산부인과학회지

OBJECTIVE: to evaluate the clinicopathologic characteristics of patients with ovarian malignant germ cell tumor. METHODS: We reviewed records of women who had malignant germ cell tumors of the ovary from 1991-2000. RESULTS: Thirty-seven women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Twenty-five women (68%) presented with stage I disease, and 12 (32%) had more advanced disease. Histology subtypes were: immature teratoma (n=16), dysgerminoma (n=9), yolk sac tumor (n=8), choriocarcinoma (n=2), embryonal carcinoma (n=1), and mixed germ cell tumor (n=1). The frequency of positive tumor markers were aFP, CA-125, beta-hCG, CA 19-9 and LDH in decreasing order. The mean age of the patients at presentation was 23.9 years (4-58). Surgical management of the 32 patients consisted of unilateral oophorectomy, or salpingo-oophorectomy, 1 woman with stage III disease underwent bilateral salpingo-oophorectomy and 4 women underwent total abdominal hysterctomy, bilateral or unilateral adnexectomy. Thirty-two women were treated with adjuvant combination chemotherapy (BEP, VAC, VBP) according to indications. The 5-year survival rate was 100%, and 5-year disease-free rate was 91.8%. Among twelve patients who attempted pregnancy, 8 succeeded in it and delivered normal full term babies. CONCLUSION: Current therapeutic strategies can allow most women with ovarian malignant germ cell tumors to have conservative surgery without compromising survival and to preserve their reproductive potential.

Meigs' syndrome associated with elevated serum CA 125 level and hemoperitoneum / 대한산부인과학회지

Meigs' syndrome is characterized by the pleural effusion and ascites in patient with soild benign ovarian tumors and the resolution of the effusions after resection of the tumor. Elevated serum carbohydrate antigen 125 (CA125) levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovary tumor. As far as I know, Meigs' syndrome with hemoperitoneum due to ruptured ovarian fibroma has not been reported yet. We present a case of Meigs' syndrome associated with elevated serum CA125 and hemoperitoneum due to ruptured ovarian fibroma.

Role of Whole Body FDG-PET in the Detection of Recurrent Uterine Cervix Cancer / 대한산부인과학회지

OBJECTIVE: We evaluated the clinical value of whole body FDG-PET to detect recurrent cervix cancer in patients with elevated serum SCC antigen levels but negative conventional imaging techniques such as CT and MRI after primary treatment for uterine cervix cancer. METHODS: Between August 1998 and January 2004, PET scans were performed on 41 patients in whom recurrent cervix cancers were suspected because serum SCC antigen levels were reelevated after primary treatment, but there were no abnormal CT or MRI findings. Recurrence was defined by monitoring serum SCC antigen levels or imaging findings of CT/MR. A value of 1.5 ng/mL was taken as the upper limit of normal of SCC antigen level. RESULTS: Positive PET findings were noted in 27 out of 41 patients, including 10 patients with distant lesions only, 8 patients with local lesions only, one patient with both local and distant lesions, 1 patient with both local lesion and paraaortic lymph node, 4 patients with both paraaortic lymph nodes and distant lesions, and 3 patients with paraaortic lymph nodes only. In detecting recurrent cervix cancer, the sensitivity, specificity, and accuracy of PET were 84.4%, 100%, and 87.8%, respectively. 27 of 41 patients were predicted as recurrence by PET scanning. CONCLUSION: Whole body FDG-PET scan is useful diagnostic tool to locate recurrent cervix cancer in patients with clinically suspected recurrence but negative conventional imaging techniques.

The Effect of subcutaneous injection of Mistletoe extract for the treatment of chronic pelvic pain / 대한산부인과학회지

OBJECTIVE: Chronic pelvic pain is pelvic pain which is not completely controlled by classical treatments. In many reports, immune alternation is related to original diseases that induce the chronic pelvic pain. Mistletoe extract has been known that it has immune modulation effect. Therefore the purpose of this study is to determine the pain-reducing effects of mistletoe extract for chronic pelvic pain that is not controlled by classical treatments. METHODS: The fitty-eight patients who visited to outpatient department of Department of Obstetrics and Gynecology, Chonnam National University Hospital due to chronic pelvic pain. Mistletoe extract (Helixor-A(R)) 5-10 mg was injected subcutaneously 3 times per week for 5 weeks, and the change of pain and short-term side-effects after injections were observed. In patients after 6 month of follow-up, the change of pain and long-term side-effects were also observed. RESULTS: In 2 of 58 patients (0.03%), treatments were discontinued doe to severe general side effect. In 48 of 56 patients (85.7%), chronic pelvic pains were improved. In 40 of 56 patients (69%), mild side effects as like mild itching were appeared and they were easily controlled by anti-histamines and conservative treatments. In 6 months after injection, general itching sensation and easily catched common cold were complaint in 4 of 10 patients. CONCLUSION: The subcutaneous injection of mistletoe extract may effective treatment method for the chronic pelvic pain that is not controlled by classical treatment. However more studies about log-term effect of mistletoe therapy are needed.

Struma Ovarii Showing the Clinical Characteristics of the Malignancy / 대한산부인과학회잡지

Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue and generally a benign germ cell tumor of the ovary. The tumor usually present with findings of an asymptomatic mature mass. Despite containing thyroid tissue, only 5% of struma ovarii have features of hyperthyroidism. Ascites have been reported in approximately 15-20% of all cases. The combination of struma ovarii and elevated CA125 has rarely been reported. We experienced an case of benign struma ovarii showing the clinical characteristics such as massive ascites, high serum CA125 level and a complex pelvic mass strongly suggestive of the malignancy. So, we report this case with a brief review of literature.

The Effect of Periovulatory Progesterone Supplementation in In Vitro Fertilization and Embryo Transfer Program / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate whether high dose progesterone intramuscular injections before oocyte retrieval and thereafter increase the implantation and pregnancy rates through improvement of uterine receptivity in patients undergoing in vitro fertilization-embryo transfer (IVF-ET). METHODS: The retrospective randomized analysis was performed in whom undergoing conventional IVF- ET at Chonnam National University Hospital Infertility Clinic from August, 1996 to July, 2001. The study group consisted of 57 patients having intramuscular progesterone injections for 4-5 days from the day of hCG injection to the day of embryo transfer and 60 patients without progesterone supplement (control group). We compared between two groups with respect to age distribution, cause of infertility, blood levels of hormone, number of aspirated ovum, number of fertilized egg, number of cleaved embryo, number of transfered embryo, embryo transplantation, cumulative embryo score, chemical and clinical pregnancy rates. RESULTS: The oocytes retrievals were done at 87 cycles in study group and 82 cycles in control group. There were no significant differences in the average age and distribution of causes of infertility. Tubal factor was the dominant cause of infertility in both groups. There were no significant differences in the number of aspirated eggs, number of fertilized eggs, cleavage rates and number of multinuclear fertilized eggs. The embryo transfer were performed 76 out of 87 cycles in study group, and 64 out of 82 cycles in control group. The average number of transferred embryos to the uterine cavity was not different, in the study and control group (2.72+/-1.64 and 2.39+/-2.03 respectively). The chemical pregnancy rate did not differ significantly (7.89% in study group, and 6.25% in control group). The clinical pregnancy rate was higher in the control group (18.75%) than in the study group (12.84%), but the result was not statistically significant. However, the number of fertilized eggs and cumulative embryo score were significantly higher in study group. CONCLUSION: High dose of progesterone supplementation before and after oocyte retrieval in IVF-ET cycles did not improve pregnancy outcome, instead showed lower pregnancy rate than no supplement group, thus we cannot consider progesterone supplementation improve endometrial receptivity and increase implantation and pregnancy rate. But, since we could improve the fertilization rate and embryo development rate through increase of the number of fertilized eggs and cumulative embryo score, further evaluation is needed in this field and we have to make vigorous efforts to increase implantation rate in IVF-ET cycles.

A Case of Intestinal Type Mucinous Adenocarcinoma and Strumal Carcinoid Tumor arising in One of Bilateral Mature Cystic Teratoma of the Ovary / 대한산부인과학회잡지

Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication occuring in approximately 1-3%. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation; squamous cell carcinoma is the most commonly associated cancer, however, adenocarcinomas or carcinoid tumors arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of postmenopausal women having mucinous adenocarcinoma and strumal carcinoid tumor simultaneously arising in one of bilateral mature cystic teratoma of the ovary. We suggest malignant transformation of MCT should be treated according to the management of the worst histologic diagnosis of the transformations if there are 2 or more malignancies are arised in MCT of the ovary.

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.

A Clinical Study of the Management of Malignant Gestational Trophoblastic Disease (1981-2001) / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to compare and analyze the effectiveness of different regimens in the treatment of malignant gestational trohphoblastic disease from 1981 to 2001. MATERIALS AND METHODS: This study included 307 patients with malignant gestational trophoblastic disease, who were admitted in Chonnam National University Hospital from 1981 to 2001. Remission rate, remission induction period, toxicity of chemotherapeutic agents depending on risk group and stages were analyzed. RESULTS: While stage I and II showed 100% of remission rate, stage III and IV showed 99.2%, 64.7% of remission rate respectively, resulting in 99.7% of overall remission rate. From 1981 to 1988, average number of cycle and periods for complete remission were 3.4 cycles and 80.3 days for low risk GTT, 6.2 cycles and 144.8 days for high risk GTT. From 1989 to 2001, average number of cycle and remission induction period were 4.1 cycles and 69.9 days, 5.3 cycles and 88.9 days, 6.6 cycles and 162.2 days for low, middle, and high risk GTT, respectively. As adjuvant therapy, 3 cases of hysterectomy and 2 cases of lobectomy were done. And radiation therapy was done on 2 cases of lung lesions and 1 cases of brain lesion. Etoposide and Actinomycin D caused less hepatotoxicity than Methotrexate did. EMA regimen shortened the overall period of treatment and caused less side effect, showing effectiveness equivalent to that of EMA CO regimen. With same therapeutic effect, less side effect and shortened administration period, EMA regimen might be able to substitute EMA CO regimen in high risk GTT. However, there should be more clinical trials before confirmation of its superior therapeutic efficacy over EMA CO regimen. CONCLUSION: When chemotherapy combined with adjuvant therapy such as operation and irradiation was done on appropriate patient group, which were selected based on risk factors and stage, it produced higher remission rate. For better therapeutic outcome, there should be further study on early detection technique and therapeutic effect of other chemotherapeutic agents.

Umbilical Venous Blood Gases, Middle Cerebral, and Renal Arterial Blood Flow Velocity Waveforms in Intrauterine Growth Restriction Fetuses / 대한주산의학회잡지

No abstract available.