A prospective multicenter randomized study on prophylactic antibiotics use in cesarean section performed at tertiary center / 대한산부인과학회지

OBJECTIVE: To determine whether the duration and timing of prophylactic antibiotics influence maternal postoperative infectious morbidity in cesarean section performed at tertiary center. METHODS: This study was a prospective, randomized trial. Pregnant women who underwent cesarean section between December 2008 and September 2009 at tertiary center were enrolled and divided into two groups: Group A, antibiotic prophylaxis was applied for 24 hours and Group B, antibiotic prophylaxis was applied for 48 hours. First generation of cephalosporin was administrated within 30 minutes prior skin incision or after cord clamping. The occurrence of postoperative infectious morbidity such as febrile morbidity, wound infection, endometritis, urinary track infection, pneumonia, sepsis and pelvic abscess and hospital stays were compared. RESULTS: There were 413 pregnant women enrolled and then randomized into 220 for group A and 197 for group B. No demographic differences were observed between two groups. The infectious morbidity was 1.9% (8/413) and wound infection was the most common postoperative infections morbidity. No significant difference was found between the groups for infectious morbidity and hospital stays. Also timing of prophylactic antibiotics did not result in significant difference for infectious morbidity. CONCLUSION: Short course of prophylactic antibiotics has been shown to be as efficacious as multidose of prophylactic antibiotics for preventing infectious morbidity in cesarean section and timing did not influence on infections morbidity. Further studies focusing on duration and timing of prophylactic antibiotics for cesarean section are needed.

Transvaginal Ultrasonographic Assessment of Cervical Length for Prediction of Preterm Delivery within 7 Days in Patients with Preterm Labor / 대한주산의학회잡지

PURPOSE: To investigate the usefulness of transvaginal ultrasonographic measurement of cervical length in patients with preterm labor for prediction of preterm delivery within 7 days. METHODS: Cervical length was measured by transvaginal ultrasound in 140 women with singleton pregnancies presenting with preterm labor and intact membranes from 24(+0) to 33(+6) weeks of gestation. Other potential predictive factors, such as Bishop score, previous history of preterm delivery, and parity were assessed. RESULTS: The mean gestational age at presentation was 30.5+/-14.7 (range, 24.0 to 33.6) weeks and the mean cervical length was 29.0+/-0.9 (range, 31.0 to 52.1) mm. Delivery within 7 days occurred in 7.9% (11/140). Receiver-operating characteristics (ROC) curves established a cervical length of 25 mm as the most relevant cut off level for prediction of delivery within 7 days. Interval between admission and delivery was significantly short when ultrasonographic cervical length was less than or equal to 25 mm. Logistic regression analysis demonstrated that the significant independent risk factors were cervical length < or =25 mm (OR: 24.64, 95% Cl: 2.97~204.20, P=0.003). CONCLUSION: Ultrasonographic cervical length measurement is a useful tool for prediction of progression to preterm delivery within 7 days with patients with preterm labor.

Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment; Kidney, Bladder, Urethra, Male and Female Reproductive Systems (Preliminary Report)

For the evaluation of the kidney impairment, serum creatinine concentrations or glomerular filtration rates are mainly used, and the conditions of solitary or transplanted kidney and chronic dialysis are also taken into the considerations. Some symptoms and signs of the chronic renal disability in spite of adequate treatment add one additional grade. For evaluating bladder and urethral impairment, the criteria include voiding symptoms and signs. The patients with urinary diversions have impairment grades depending on the alteration of upper urinary tract function. For penile impairment, the degrees are evaluated using the international index of erectile function, nocturnal penile tumescence and color doppler ultrasonography. For evaluating impairment of other male reproductive organs, functional and anatomical changes of these organs, analysis of the semen or hormones and the state of solitary testis are used as the criteria. For evaluating impairment of female reproductive organs, pregnancy potential, requirement of continuous treatment and the ability of sexual intercourse are used. Also, degree of impairment is modified according to the ages in evaluating female reproductive systems. We have tried to make this evaluation system objective, scientific, and convenient, but still find it leaving much to be desired.

A case of primary transitional cell carcinoma of the ovary / 대한산부인과학회지

Primary ovarian transitional cell carcinoma (TCC) is extremely rare type of tumor and resembles transitional cell carcinoma of the bladder. Primary ovarian TCC has been classified as a different subtype from malignant Brenner tumor for it's histologic and clinical characteristics. It usually presents at an advanced stage .Though more aggressive than malignant Brenner tumor, it shows more favorable prognosis because of better response to the chemotherapy than other epithelial ovarian carcinomas. We experienced a case of primary ovarian transitional cell carcinoma in a premenopausal woman who underwent staging operation and chemotherapeutic treatment, and herein report the case with a brief review of related literatures.

Clinical study on obstetric variables affecting perinatal mortality in placental abruption / 대한산부인과학회지

OBJECTIVE: To evaluate obstetric variables in the placental abruption that affect on perinatal mortality. METHODS: We reviewed clinical data of all singleton deliveries complicated with placental abruption between January 2000 and December 2007, in Department of Ob. & Gyn., Sanggye Paik Hospital. RESULTS: Placental abruption complicated 54 cases (0.55%) of all deliveries (n=9,903) from January 2000 to December 2007. The peak age was 26-30 years (42.1%). The most common symptom was vaginal bleeding (57.4%) and intrauterine fetal death had already occurred in 9.3%. Perinatal mortality rate was 13.0% and there was no maternal death. 38.9% of placental abruption occurred between 33 to 36weeks of gestational age. 38.9% of placental abruption was diagnosed before delivery with ultrasonography and 9.3% was chronic placental abruption. 33.3% of placental abruption was associated with preeclampsia, and then associated with PPROM (24.1%), uterine myoma (3.7%), chronic hypertension (1.9%) and smoking (1.9%). When the hypertensive disorders were associated, fetal distress rate was higher than normotensive pregnancy (63.2% vs 20.0%, P-value: 0.005). Mean gestational age (days) (194+/-32.8 vs 248.12+/-28.0, P-value<0.001) and the severity of placental abruption (P-value: 0.005) affect perinatal mortality in placental abruption. The most common complication of placental abruption was DIC (16 cases, 29.6%), followed by Couvelaire uterus (4 cases, 7.4%) and uterine rupture (1 case, 1.9%). CONCLUSION: Obstetric variables that affect perinatal mortality were gestational age at the diagnosis and the severity of placental abruption.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Identification of biomarker for ovarian cancer by serum proteomic analysis using SELDI-ToF-MS / 부인종양

OBJECTIVE: SELDI-ToF-MS is an affinity-based mass spectrometric method. This study was performed to determine feasibility of serum proteomic pattern analysis using SELDI-ToF-MS for the detection of ovarian cancer. METHODS: Forty-three epithelial ovarian cancer patients and seventy-seven controls were included in the study from October 2003 to March 2005 in Sanggye Paik Hospital. Potential tumor biomarkers in sixty serum samples were screened, including twenty-one ovarian cancers and thirty-nine controls. Proteomic pattern was analyzed by SELDI-ToF-MS and optimal discriminating m/z value with proper cutoff of log-normalized intensity was determined by decision tree analysis (Phase I). Another sixty serum samples were obtained from twenty-two ovarian cancers and thirty-eight controls. Through analysis using SELDI-ToF-MS, the performance of diagnosing ovarian cancer was determined by applying previously adopted cutoff log-normalized intensity of m/z value determined in Phase I experiment (Phase II). RESULTS: A biomarker of 3501.23 kDa was selected based on the collective contribution to the optimal separation between ovarian cancers and controls. Sensitivity of 90.9% and specificity of 84.2% was achieved by SELDI-ToF-MS in Phase II experiment. Age, stage, and histologic type did not affect performance of SELDI-ToF-MS for diagnosing ovarian cancer. CONCLUSION: Serum proteomic analysis by biochip and mass spectrometry is a feasible method in diagnosing ovarian cancer.

Alloimmunization to Granulocyte Antigens among Korean Pregnant Women / 대한수혈학회지

BACKGROUND: Neonatal alloimmune neutropenia (NAN) is one of the diseases resulting from the transplacental passage of granulocyte antibodies directed against the neonates' neutrophil surface antigens. In order to cause NAN, mothers should be first alloimmunzied against the neutrophil antigens. However, there are no reports on the incidence of granulocyte antibodies in pregnant women or the target antigens of the antibodies in Korea. METHODS: Pregnant women, who visited the outpatient clinic of Obstetrics for antenatal care and had given birth to babies, were enrolled in this study. A total of 650 serum were tested for the granulocyte antibody by a mixed passive hemagglutination assay (MPHA). When an antibody was detected, MPHA was re-performed with the HLA antibody adsorbed serum to differentiate the granulocyte antibody from the HLA antibody. When a granulocyte antibody was confirmed, the patient's granulocyte antigens were typed to support her alloimmnization against the granulocyte antigen. Neutropenia in the neonates, in whose mother's serum granulocyte antibody had been confirmed, was detected by drawing pairs of EDTA and serum samples (n=15) from the neonates between 12 and 24 hours of age. MPHA was then performed using the neonate's serum, and granulocyte antigen typing was typed to confirm NAN. RESULTS: MPHA showed a positive reaction in the sera from 23 women (3.5%, 23/650). Granulocyte antibodies were confirmed in the sera from 15 women (2.3%, 15/650). Among the 15 neonates, whose mothers had granulocyte antibodies in their sera, only two showed neutropenia, and only one had the granulocyte antibody (anti-HNA-1b) in its serum with a fetomaternal granulocyte antigen mismatch. CONCLUSION: In this study, the incidence of granulocyte antibodies in pregnant women was 2.3% (15/650), and the estimated incidence of NAN among live births in Korea was 0.2% (1/650).

Clinical characteristics and prognosis of peripartum cardiomyopathy / 대한산부인과학회지

OBJECTIVE: To examine clinical characteristics and risk factors and to assess prognosis of peripartum cardiomyopathy (PPCM). METHODS: We retrospectively reviewed the medical records of 10 patients with confirmed PPCM by clinical symptoms and echocardiography, who delivered between January 1995 and December 2005 at our Hospital. Clinical and serial echocardiographic data of these patients were collected. RESULTS: Mean maternal age at the time of diagnosis was 28.8+/-3.2 years and the mean gestational age was 37(+3)+/-4 weeks. Common associated conditions were nulliparity (90%), cesarean delivery (70%), anemia (70%), preeclampsia (60%), transfusion before diagnosis (40%), twin pregnancy (30%). At the time of diagnosis, the mean left ventricular ejection fraction (EF) was 42.84+/-9.69%, fractional shortening (FS) was 23.41+/-5.49%, and left ventricular end diastolic dimension (LVEDD) was 5.58+/-0.55 cm/m2. Normalization of left ventricular function occurred in 8 patients (80%). After recovery of the left ventricular function, mean EF was 61.41+/-4.21%, FS was 34.08+/-3.26%, and LVEDD was 4.68+/-0.76 cm/m2. Incidence of PPCM was 1 in 2455 pregnancies, and maternal mortality was 12.5% in 10 months follow-up. CONCLUSION: The risk of PPCM may increase in puerperal women with rapid dramatic hemodynamic change. Echocardiography may provide significant prognostic information.

Correlation between Ultrasonographic Findings of Endometrioma and Endometriosis Stage and Recurrence / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate of correlation between ultrasonographic findings of endometrosis and endometriosis stage and recurrence. METHODS: We reviewed medical records of fifty-nine patients who admitted the department of Obstetrics and Gynecology of Sanggye Paik Hospital from April 1998 to June 2004 and were surgically confirmed endometriosis stage 3-4. GnRH agonist was injected every 4 weeks after the first injection following initial operation and a total of six doses were injected to a patient. We performed ultrasonographic examination of pre- and post-operation at an interval of 3 or 6 months. The endometriotic ultrasonographic findings were classified into three group; low-level internal echo (LIE), LIE and septation, LIE and hyperechoic wall foci. The correlation between ultrasonographic finding of endometrioma and endometriosis stage and recurrence were analyzed by Fisher's exact test and Pearson's chi-square test. RESULTS: The follow-up periods after operation were about 11.9 months. Typical ultrasonographic findings of endometrioma were observed on 50 of 59 patients, diagnostic performance of ultrasound in the detection of endometrioma had a 84.7% sensitivity in this study. In 50 cases, 48% (n=24) had a only low-level internal echoes, 32% (n=16) had a low-level internal echoes and multiple septation, 20% (n=10) had a low-level internal echoes and hyperechoic wall foci. The most common ultrasonographic findings were LIE (50%) in stage 3, LIE and septation (33.3%) in stage 4. During follow-up we observed ultrasonographic recurrence in 6 (10.2%) cases. There were no statistically significant correlation between ultrasonographic finding and endometriosis stage or recurrence. CONCLUSION: Ultrasound is a convenient and reliable method for diagnosis of endometrioma. But, it appears that ultrasonographic findings of endometrioma not correlate with endometriosis stage or recurrence. Further long term follow-up studies in large scale is needed for correlation between ultrasonographic findings of endometriosis and clinical significance.

Epidemiologic Analysis of Sexual Assault Victims in Northeast Area of Seoul / 대한산부인과학회지

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.

Epidemiologic Analysis of Sexual Assault Victims in Northeast Area of Seoul / 대한산부인과학회지

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.

Study for umbilical cord plasma leptin in gestational diabetes and normal pregnancy / 대한산부인과학회지

OBJECTIVE: To compare umbilical cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects and to evaluate the regulation of leptin in GDM. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human Leptin RIA kit; Linco Research, Inc. USA). We compared cord plasma leptin level between gestational diabetes (n=18 women) and control pregnancies (n=21 women). RESULTS: Maternal weight, fetal birth weight, Ponderal index and placental weight were significant variables among the demographic variables. There was statistical difference in cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects (Control subjects: 4.8 [3.7-7.9]ng/mL, GDM women: 8.0 [6.6-11.9]ng/mL, P=0.022). There was also statistical difference in the ratio between cord plasma leptin level and birth weight (Control subjects: 0.001 [0.001-0.002]ng/mL/gm, GDM women: 0.002 [0.002-0.003]ng/mL/gm (P=0.022)), and between cord plasma leptin level and Ponderal index (Control subjects: 0.280 [0.217-0.579], GDM women: 0.605 [0.452-1.005], (P=0.008)). There was no difference in gender. CONCLUSION: We found significant difference in umbilical cord plasma leptin level and adjusted leptin level for fetal birth weight, Ponderal index and placental weight between infants of mothers with gestational diabetes and infants of control subjects. It is suggested that umbilical cord plasma leptin is produced by fetal fat tissue, but it is more complicatedly regulated by placenta and other factors in gestational diabetes.

Normalization of serum SCC-Ag by surgical removal of maxillary inverted papilloma during follow-up of cervical carcinoma: a case report / 부인종양

Squamous cell carcinoma antigen (SCC-Ag) is a well-established tumor marker for monitoring recurrence of squamous cell carcinoma of the cervix. However, serum levels of SCC-Ag could be elevated by some benign conditions not to speak of squamous cell malignancies other than cervical carcinoma. Sinonasal inverted papilloma is one of benign tumor which may elevate serum SCC-Ag level. We experienced a case of cervical carcinoma patient whose serum level of SCC-Ag was not normalized in spite of combination chemotherapy until surgical removal of maxillary inverted papilloma detected by PET/CT.

Clinical review of midtrimester amniocentesis / 대한산부인과학회지

OBJECTIVE: To compare the usefulness of prenatal screening tests for chromosomal abnormalities by analyzing the cytogenetic results of midtrimester amniocentesis METHODS: We reviewed a total of 1264 cases of midtrimester prenatal genetic amniocentesis performed from February 1997 to September 2003, of which accorded to indications of cytogenetic studies. Cytogenetic results were analyzed with the distribution of maternal age, indications of amniocentesis. RESULTS: The most common age of total subjects was in between 35-39 years (37.1%). The indications of amniocentesis were abnormal maternal serum marker (60.0%), advanced maternal age (34.8%), abnormal ultrasonographic findings (3.2%), in order. The overall incidence of chromosomal aberration was 3.9% (49/1264). No significant difference was found between the mean maternal age with and without abnormal fetal karyotype. According to indications, there was 12.5% (5/49) of chromosomal abnormalities in abnormal sonographic finding group, 5.2% (36/688) in abnormal maternal serum screening group and 2.4% (12/498) in advanced maternal age group. There was statistical significance (P=0.004) only in abnormal ultrasonographic finding group. CONCLUSION: Ultrasonography was become to be more important due to development of high resolution ultrasonography, skillful technique and awareness of sonographic markers. Ultrasonographic abnormality could be the most predictive marker for abnormal fetal karyotypes.

Factor V Leiden mutation in Korean women with pregnancy-induced hypertension / 대한산부인과학회지

OBJECTIVE: The purposes of this study was to evaluate the frequency of Leiden mutation (missense mutation in the factor V gene at exon 10, 1691 CGA to CAA) in Korean women with well characterized pregnancy-induced hypertension (PIH) compared with normotensive gravid women. METHODS: Genomic DNA from 121 PIH cases and 98 normotensive pregnant control cases were used for polymerase chain reaction (PCR). To genotype Leiden mutation (missense mutation in the factor V gene, exon 10 (1691 G to A)), primers (5'-TGC CCA GTG CTT AAC AAG ACC A-3', 5'-TGT TAT CAC ACT GGT GCT AA-3') were employed to make 267 base pair (bp) PCR product. There was an initial denaturation at 94 degrees C 5 min, followed by 30 cycles of one minute at 94 degrees C, one minute at 55 degrees C, and one minute at 72 degrees C. A 267 bp PCR product was further digested with Mnl I for 2 hour at 37 degrees C and analysed through 12% polyacrylamide gel electrophoresis to determine genotype. Allele 1691G yielded 37 bp, 67 bp, 163 bp fragment and allele 1691A yielded 67 bp, 200 bp fragment. RESULTS: We examined the genotypes of factor V of 121 Korean women with pregnant induced hypertension and 98 normal pregnant women. None of the 219 Korean women carried the factor V Leiden mutation. CONCLUSION: The factor V Leiden mutation is absent and not a common cause of PIH in Korean women.

Performance of Risk Indices for Prediction of Osteoporosis in Post- and Perimenopausal women / 대한산부인과학회지

OBJECTIVE: To examine the ability of published osteoporosis risk indices for prediction of osteoporosis in post- and perimenopausal women. METHODS: Subjects included 1559 of post- and perimenopausal women, 45 year old and older, recruited from Menopause Clinic from January 2002 to June 2004. Their bone mineral density (BMD) of femur neck was determined by dual energy x-ray absorptiometry (DXA), and their historical and clinical risk factors were assessed. We employed the World Health Organization (WHO) diagnostic criteria of osteoporosis for calculating the T scores, using race/ethnic and gender-specific young adult mean values. We applied 6 published osteoporosis risk indices (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) to each subject. Also, the predictive abilities of risk indices were assessed using the area under receiver operating characteristic (ROC) curve. RESULTS: The prevalence of osteoporosis and osteopenia was 8.7% and 32.6% for femur neck, 16.0% and 30.1% for lumbar spine, respectively. The prevalence of osteoporosis for femur neck was increased dramatically in the coming decades (1.6% for fifties, 8.7% for sixties, 43.0% for seventies, 64.1% for over eighties). ROC curve for predicting osteoporosis according to femur neck by OSTA showed the area under the curve (AUC) of 0.920. Sensitivity, specificity, and positive predictive value (PPV) were 93.4%, 75.4%, 26.6%, respectively. AUC for ORAI, SCORE, SOFSURF, ABONE, and NOF practice guideline was 0.896, 0.916, 0.871, 0.846, and 0.856, respectively. CONCLUSION: Validated risk indices have varying complexity, but similar sensitivity, specificity, and PPV for identifying individuals who are likely to have osteoporosis. However, OSTA is the most excellent risk index and simple tool.

Evaluation of NeonatalImmature Reticulocyte Fraction in Small-for-gestational Age Infant in Umbilical Cord Blood / 대한산부인과학회잡지

OBJECTIVE: To evaluate the immature reticulocyte fraction (IRF) by automated calculator that have played a role of predicting marker for hematopoiesis induced by perinatal asphyxia. METHODS: Hospital charts of 40 neonates with diagnosis of small for gestational age (SGA: birth weight <10 percentile) and 47 babies of appropriate for gestational age (AGA) who were delivered vaginally between May 8, 2000 and March 2, 2002 at department of Obstetric and Gynecology, Sanggye Paik Hospital, Inje university. About 5 cc in cord blood was collected immediately after delivery, the calculation of nucleated RBC (N-RBC)/100WBC by macroscopic exam and the evaluation of reticulocyte maturation by automated reticulocyte calculator (Sysmex SE 9000, TOA Medical Electronics Co., Ltd, Kobe, Japan) were performed, and made a comparative study of apgar score. RESULTS: The comparison between AGA and SGA infants, the mean values of cord blood sampling parameter N-RBC (3.53 +/- 4.89 vs 7.92 +/- 10.06, P=0.016), middle fluorescence ratio reticulocyte (MFR) (0.21 +/- 0.02 vs 0.23 +/- 0.03, P<0.001), high fluorescence ratio reticulocyte (HFR) (0.08 +/- 0.03 vs 0.12 +/- 0.03, P<0.001), IRF (0.28 +/- 0.03 vs 0.35 +/- 0.05, P<0.001) were obtained. All of the parameters were significantly different between SGA infants and normal infants and IRF was more valuable marker than N-RBC in evaluation of hematopoietic activity in SGA infants (multiple logistic regression analysis: P value 0.282 vs <0.001). CONCLUSION: Immature reticulocyte fraction by automated calculator is more accurate and confident marker better than N-RBC/100WBC by manual countingin evaluation of the fetal hypoxic induced hematopoiesis.

Clinical and Pathologic Study of Abnormal Uterine Bleeding in Premenopausal Women-To Evaluate the Prognostic Variables of Endometrial Hyperplasia / 대한산부인과학회잡지

OBJECTIVE: We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia. METHODS: We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5). RESULTS: Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher. CONCLUSION: In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.

Gemcitabine as second-line chemotherapy in patients with recurrent epithelial ovarian cancer: Review of four cases / 대한산부인과학회잡지

Adjuvant multiagent chemotherapy with platinum and paclitaxel after optimal cytoreductive surgery decisively improved survival rates of patients with epithelial ovarian carcinoma. However, more than two- thirds of patients with advanced disease will encounter tumor progression, underlining the need for effective second-line strategies. Continued efforts to discover new active agents for the treatment of patients with ovarian carcinoma had identified gemcitabine. Four patients with epithelial ovarian carcinoma, who were treated in Inje University Sanggye Paik Hospital and recurred thereafter received gemcitabine 1,000 mg/m2 as a 30 min intravenous infusion on days 1, 8, and 15, which was repeated every 28 days. The disease progressed in two patients, while one showed stable disease and another reached complete response. One patient expired of disease two months after the completion of therapy. Grade 3 leukopenia was successfully managed using G-CSF. Regrowth of hair lost during previous chemotherapy occurred in all subjects. We report four cases of advanced recurrent ovarian carcinoma which were treated with gemcitabine.