Prenatal Sonographic Diagnosis of Cephalopagus Twins Associated with Multiple Anomalies / 대한산부인과학회잡지

Conjoined twins are uncommon complications of monoamniotic twinning. Among them, cephalopagus twins are very rare. The accurate prenatal diagnosis of conjoining is essential for the optimal obstetric counseling and management. We describe a case where prenatal sonographic diagnosis of cephalopagus associated with multiple anomalies including meningomyelocele, diaphragmatic hernia, omphalocele, and club feet was made at 18 weeks of gestation.

A Clinical Study of Unruptured Ectopic Pregnancies with the Treatment of Systemic or Local Methotrexate Injecton / 대한산부인과학회잡지

OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.

Transverse uterine incision closure: One versus Two layers / 대한산부인과학회잡지

OBJECTIVE: Closure of a low transverse cesarean incision with one layer and two layer, we compared operative time, hemostasis, blood loss and postoperative sonohysteroperitoneographic findings. Study design: At our hospital 103 women were randomized to closure of a low transverse cesarean incision with either one continuous layer of a locking No. 1 chromic suture or two continuous of No. 1 chromic suture with the first layer locked between Mar. 1, 1998 and Dec. 31, 1998. After three months later, sonhysteroperitoneography was taken and then we evaluated uterus indirectly. RESULTS: A one layer closure required less operative time, 16 versus 20.8 minutes (p<0.01), less hemoglobin change, 0.44 versus 1.3 (p<0.01) and less suture materials (p<0.01). But postoperative follow up sonohysteroperitoneography, a one layer closure shows slightly thinning of isthmic layer of myometrium, two layer closure shows more adhesional band and both are similar other findings. CONCLUSION: A one layer does not significantly affect the clinical course than traditional two layer closure. So we recommended a one layer closure when its use is anatomically feasible.

Lectins Binding in Squamous Cell Carcinoma of the Uterine Cervix as a Diagnostic and Prognostic Marker / 대한산부인과학회잡지

OBJECTIVE: The aim of the study was to evaluate the corelation between an expression of lectins and survival of patients with squamous cell carcinoma of uterine cervix. METHODS: The cell surface carbohydrate profile of formalin-fixed paraffin embedded tissue section of squamous cell carcinoma of the uterine cervix was evaluated using ulex europaeus agglutinin(UEA-1), peanut agglutinin(PNA), dolichos biflorus agglutinin(DBA), soybean agglutinin(SBA) and lotus tetragonobus lectin(LTL) by the avidin-biotin complex method. Fifty-one cases of squamous cell carcinoma and 10 cases of normal squamous epithelium of the uterine cervix were selected from the file which were treated during Jan. 89 to 31 Dec. 1992 in Department of Obstetrics and Gynecology, Korea University Hospital. RESULTS: UEA-1 and LTL were negative in normal cervix while positive in 76.5%, 47.1% of squamous cell carcinoma respectively, and useful markers for differential diagnosis between normal and squamous cell carcinoma. SBA and LTL were useful for differential diagnosis of keratinizing and non-keratinizing squamous cell carcinoma. UEA-1 may play an important role in lymphovascular invasion of squamous cell carcinoma of the uterine cervix. CONCLUSIONS: There was no correlation among clinical staging, patient's survival and lectins binding in squamous cell carcinoma.

Follow-up Study of 119 cases of Fetal Choroid Plexus Cysts in the Second Trimester: Associated with Trisomy 18? / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. METHODS: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. "Isolated CPCs" were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. "CPCs in high-risk population" were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; P0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25+/-3 and 26+/-3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal. CONCLUSION: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.

Transitional Cell Carcinoma of the Ovary / 대한산부인과학회잡지

Transitional cell carcinoma of the ovary is extremely rare tumor and the category of transitional cell carcinoma has been proposed for those tumors in which definite urothelial features are present but no benign, metaplastic, and/or proliferating Brenner tumor is identified. We report a case of primary transitonal cell carcinoma of the ovary in 48-year old woman who presented with low abdominal pain and dyspepsia. Brief literature was reviewed about the features of its behavioral aggressiveness and characteristic chemosensitivity.