Effect of human papillomavirus genotype on severity and prognosis of cervical intraepithelial neoplasia

OBJECTIVE: This study evaluated the effect of the specific human papillomavirus (HPV) genotypes on severity and prognosis in cervical intraepithelial neoplasia (CIN) patients. METHODS: The medical records of 446 patients treated with loop electrosurgical excision procedure (LEEP) were reviewed. The severity of CIN was categorized as CIN1/CIN2 versus CIN3+ including CIN3 and carcinoma in situ (CIS). HPV genotypes were categorized as 1) low risk, 2) intermediate risk, 3) high risk/HPV 16, 4) high risk/HPV 18, and 5) unclassified. Progression was defined as abnormal cytology, including atypical squamous cells, low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion. The margin status and progression free survival (PFS) by HPV genotypes were analyzed in 355 women with three months or more of post-treatment records. RESULTS: CIN3+ was the most common CIN type (67.7%), and high risk/HPV 16 (26.9%) was the most common genotype. Intermediate risk (P < 0.01), high risk/HPV 16 (P < 0.01) and high risk/HPV 18 (P < 0.01) were significantly more common in women with CIN3+ than CIN1/CIN2. Patients with high risk/HPV 18 showed the highest rate of positive margins (P < 0.01). The margin status proved to be the only statistically significant factor affecting PFS. CONCLUSION: The proportion of positive margins was significantly different by HPV genotypes and highest in high risk/HPV 18 group. CIN patients with high risk/HPV 18 need to be more carefully tracked than patients with the other HPV genotypes.

The Clinico-Pathologic Features and Significance of Preoperative CA 125 in Patients Who Had an Operation for Ovarian Tumors / 대한폐경학회지

OBJECTIVES: The aim of this study is to confirm the clinical and histopathologic findings of ovarian tumors and determine the malignancy before operation. It will attribute to early diagnosis, determining direction of treatment and improving prognosis of malignant ovarian tumor. METHODS: Seven hundred sixty-five patients who had an operation for ovarian tumors in the department of Obstetrics and Gynecology of Gachon University Gil Medical Center from April 2007 to December 2009 were enrolled as subjects. A retrospective analysis of age, parity, menopausal status, preoperative CA 125, histology, ultrasound, and treatment method was done. RESULTS: 1. Among benign ovarian tumors, endometrial cyst (211 cases, 30.1%) was most common and had the highest preoperative CA 125 (76.07 U/mL). 2. Among borderline ovarian tumors, mucinous type (16 cases, 62.5%) was most common, but preoperative CA 125 was higher in serous type (144.38 U/mL) than mucinous type (82.59 U/mL). 3. Among malignant ovarian tumors, serous adenocarcinoma (14 cases, 29.8%) was most common, and undifferentiated carcinoma had the highest preoperative CA 125 (500.0 U/mL). 4. The preoperative CA 125 showed a tendency to increase in relation to stage in malignant ovarian tumors. 5. Age, preoperative CA 125, menopausal status and ultrasound finding were identified as discriminating factors for malignancy and relative risk of them were 7.19, 7.90, 5.56 and 61.43, respectively. CONCLUSION: Using the combination of age, menopausal status, preoperative CA 125 and ultrasound to diagnose ovarian tumors before the operation will be a help to early diagnosis and determining the treatment and improve prognosis.

Small bowel herniation through trocar site after operative laparoscopy / 대한산부인과학회지

Small bowel herniation after operative laparoscopy is an uncommon but serious complication that can result in bowel resection. Therefore, it is important to prevent and diagnose early. We experienced a case of small bowel herniation through trocar site and present with a brief review of literatures.

Management of voiding dysfunction after anti-incontinence operation / 대한산부인과학회지

With the increasing number of surgery for incontinence, voiding dysfunction after anti-incontinence surgery will continue to be a problem. The patient with postoperative voiding dysfunction may present with primarily storage symptoms or voiding symptoms, or a combination of both. Detailed knowledge of the preoperative voiding status may aid in the diagnosis of voiding dysfunction. Diagnosis is based on history, physical examination, urinalysis and postvoid residual volume, but additional informations from urodynamic study and cystoscopy are useful. Patients with postoperative voiding dysfunction should be initially treated conservatively with intermittent or continuous catheterization, fluid restriction, anticholinergics and pelvic floor physiotherapy. When conservative treatment fails, surgical intervention should be done. It is important to distinguish between midurethral sling and other procedures because the timing and type of intervention vary. In case of midurethral sling, loosening or cutting the tape has had excellent results. Prevention of obstruction during surgery may be the best way to avoid reoperation.

A study on the changes of sperm motility according to freezing and thawing methods / 대한산부인과학회지

OBJECTIVE: To figure out the more optimal method for freezing and thawing the sperm, we compared with the sperm motility after handling of the sperm based on the different types of freezing and thawing methods. METHODS:Twenty four adult males who visited our infertility clinic from Aug 2004 to Feb 2005 were enrolled. We applied two kinds of freezing method to normal sperm according to WHO standard criteria; automatic slow freezing method (Auto) and manual vapor freezing method (Manu). We also use two different methods of thawing; a 37 degreesC warm water bath (37 degreesC) and 22 degreesC room temperature thawing (22 degreesC). Mean motile percent (MMP) was compared by the freezing methods and thawing methods respectively. We also evaluated the motility in four different ways of freezing and thawing combination. A written informed consent was obtained from each client. This study was approved by IRB. RESULTS: MMP by the freezing method was 56% in Auto group and 52% in Manu group. It was significantly different (P=0.037). In thawing method, it was 59% in 37 degreesC group and 49% in 22 degreesC group (P=0.000). Each of freezing and thawing methods was joined to make four different types of freezing and thawing combinations. In MMP there were 63% in Auto/37 degreesC, 50% in Auto/22 degreesC, 56% in Manu/37 degreesC and 48% in Manu/22 degreesC (P>0.05). CONCLUSION: The automatic method in freezing and room temperature in thawing showed respectively the highest MMP. In four different types of freezing and thawing combinations, Auto/37 degreesC MMP was the highest. There was no statistical difference. This means that all four types of freezing and thawing methods might be used clinically. If further study of larger population or comparison of fertility is done, we would have a better result.

A Case using Uterine Artery Embolization for the Patient with Uterine Artery Bleeding after Transobturator Tape Operation

The transobturator tape (TOT) procedure is a relatively safer than tension-free vaginal tape (TVT) operation but it may cause vascular injury. Recently we experienced a case using uterine artery embolization for the patient with uterine artery bleeding after TOT.

A study on the changes of sperm motility according to freezing and thawing methods / 대한산부인과학회지

OBJECTIVE: To figure out the more optimal method for freezing and thawing the sperm, we compared with the sperm motility after handling of the sperm based on the different types of freezing and thawing methods. METHODS:Twenty four adult males who visited our infertility clinic from Aug 2004 to Feb 2005 were enrolled. We applied two kinds of freezing method to normal sperm according to WHO standard criteria; automatic slow freezing method (Auto) and manual vapor freezing method (Manu). We also use two different methods of thawing; a 37 degreesC warm water bath (37 degreesC) and 22 degreesC room temperature thawing (22 degreesC). Mean motile percent (MMP) was compared by the freezing methods and thawing methods respectively. We also evaluated the motility in four different ways of freezing and thawing combination. A written informed consent was obtained from each client. This study was approved by IRB. RESULTS: MMP by the freezing method was 56% in Auto group and 52% in Manu group. It was significantly different (P=0.037). In thawing method, it was 59% in 37 degreesC group and 49% in 22 degreesC group (P=0.000). Each of freezing and thawing methods was joined to make four different types of freezing and thawing combinations. In MMP there were 63% in Auto/37 degreesC, 50% in Auto/22 degreesC, 56% in Manu/37 degreesC and 48% in Manu/22 degreesC (P>0.05). CONCLUSION: The automatic method in freezing and room temperature in thawing showed respectively the highest MMP. In four different types of freezing and thawing combinations, Auto/37 degreesC MMP was the highest. There was no statistical difference. This means that all four types of freezing and thawing methods might be used clinically. If further study of larger population or comparison of fertility is done, we would have a better result.

Comparison on effects and complications of tension-free vaginal tape and transobturator tape in the surgical management of female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to compare the effectiveness and complications between TVT and TOT in the surgical management of female stress urinary incontinence. METHODS: From December, 2005 to July, 2006, 72 patients were performed anti-incontinence surgery at our hospital. Group of TVT surgery were 35 cases and group of TOT surgery were 37 cases. We reviewed medical records and analyzed these cases about age, parity, weight, height, severity of incontinence, operation time, operation outcome, duration of hospitalization and complications. RESULTS: There were no differences in patients' mean age, parity, weight, height, menopausal status and severity of incontinence. Mean operation time of TOT group (40.2+/-30 min) was shorter than TVT group (46.7+/-32.4 min), but there was no statistical difference. In case of excluded LAVH, mean operation time of TOT group (21.4+/-9.4 min) was significantly shorter than TVT group (27.0+/-7.7 min). There were no statistical differences on mean hemoglobin drop and mean hospital stay. The objective rates of cure (88.6% vs 86.5%), improvement (5.7% vs 8.1%), and failure (5.7% vs 5.4%) were similar for the TVT and TOT groups, respectively. The subjective rates of cure (80% vs 81.1%), improvement (14.3% vs 13.5%), and failure (5.7% vs 5.4%) were similar for the TVT and TOT groups, respectively. In case of bladder perforation, TVT group (2 cases) was higher than TOT group (0 case) but there was no statistical difference. In case of vaginal erosion, urinary tract infection, pelvic hematoma, de novo overactive bladder, there were no statistical differences. CONCLUSION: The TVT and TOT are both effective surgical treatment for stress urinary incontinence. Especially, TOT is safe and time saving procedure because it needs no cystoscopy.

Clinical analysis of tension free vaginal tape combined with hysterectomy / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the efficacy, safety and complications of tension-free vaginal tape (TVT) combined with total hysterectomy under general anesthesia. METHODS: Retrospective comparison of 76 women treated by TVT procedure with total hysterectomy from January 2003 to December 2003. All patients had undergone preoperative evaluation including history taking, physical examination, pelvic examination, 1-hour pad test and urodynamic test, and then were operated under general anesthesia. There were 65 patients combined with LAVH (laparoscopic assisted vaginal hysterectomy), 6 patients combined with VTH (vaginal total hysterectomy) and 5 patients combined with TAH (total abdominal hysterectomy). RESULTS: The mean follow up and hospital day were respectively 13 months (range 6-18 months) and 7.6 days (range 6-15 days). Objective and subjective success rate were respectively 97.4% (cured 92.1%, improved 5.3%) and 97.4% (cured 88.1%, improved 9.3%). Preoperative and postoperative 1-hour pad test were respectively 36.4 gm and 4.1 gm (p<0.001). Complications were bladder perforation (6.6%), voiding dysfunction (7.9%) and overactive bladder syndrome (7.9%). CONCLUSION: Conclusively, the cure rate was 88.1% in the TVT combined with hysterectomy when performed under general anesthesia.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Comparison study on results of LAVH according to prior abdominal surgery / 대한산부인과학회지

OBJECTIVE: To evaluate the result of laparoscopically assisted vaginal hysterectomy (LAVH) according to history of prior abdominal surgery. METHODS: From January, 2003 to June, 2005, a total of 504 patients were performed LAVH at our Hospital. The patients were divided into 2 groups: Group of non prior abdominal surgery (Op. Hx(-) group) included 262 cases and group of prior abdominal surgery (Op. Hx(+) group) had 242 cases. We reviewed medical records and analyzed these cases regarding age, parity, weight, height, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: There were no differences in terms of patients' mean age, parity, weight and height, and indications for surgery between the two groups. Mean operation time of Op. Hx(+) group (86.9+/-28.2 min) was longer than Op. Hx(-) group (80.7+/-20.0 min). There was no statistical difference on mean postoperative hemoglobin drop and mean uterine weight between the 2 groups. Mean hospital stay of Op. Hx(+) group (4.6+/-1.7 days) was longer than Op. Hx(-) group (4.3+/-0.9 days). The incidence of major surgical complications was higher in Op. Hx(+) group (10 cases - 4.1%) than Op. Hx(-) group (3 cases - 1.2%). In case of blader injury, Op. Hx(+) group (5 cases) was higher than Op. Hx(-) group (0 case). Op. Hx(+) group had 2 ureteral injuries and 1 rectal injury but there were no statistical differences. In case of trocar site bleeding, both group had 2 cases trocar site bleeding respectively. Op. Hx(-) group had 1 inferior vena cava injury but there was no statistical difference. CONCLUSION: At the time of LAVH, the incidence of bladder injury was higher in group of patients with history of prior abdominal surgery. So special attention should be paid to prevent bladder injury.

Maternal Morbidity and it's Risk Factors in Eclamptic Woman / 대한산부인과학회잡지

OBJECTIVE: To identify risk factors for maternal morbidity in eclamptic woman. METHODS: A retrospective analysis was performed on the record of eclamptic woman during from August 1989 to February 2002. Univariate analysis was used to determine which of the independent variables were significantly different between two groups (antepartum vs postpartum). RESULTS: The incidence of eclampsia was 1 in 1,795 deliveries and the maternal mortality rate was 4.3%. Maternal complications associated with eclampsia were abruptio placentae (13.0%), pulmonary edema (26.1%), acute renal failure (39.1%), HELLP syndrome (30.4%), disseminated intravascular coagulopathy (8.7%), neurologic sequelae (8.7%), maternal death (4.3%). One patient died from disseminated intra- vascular coagulopathy, sepsis, and multiorgan failure after postpartum eclampsia. Women with antepartum eclampsia had higher incidence of acute renal failure (44.4% vs 20%) and HELLP syndrome (33.3% vs 20%) than did in women with postpartum eclampsia. Conversely, women with postpartum eclampsia had higher incidence of disseminated intravascular coagulopathy (6.7% vs 20%) and neurologic sequelae (6.7% vs 20%). CONCLUSION: Early detection and management of preeclampsia can prevent the eclampsia and maternal mortality and morbidity.

Effects of Oligohydramnios on Perinatal Outcome and Latency Period in Patients with Preterm Premature Rupture of Membranes / 대한주산의학회잡지

OBJECTIVES: To examine the effects of the oligohydramnios on perinatal outcome and latency period in patients with preterm premature rupture of membranes. METHODS: We performed a retrospective analysis of 98 singleton pregnancies complicated by preterm premature rupture of membranes, with delivery between 26 and 35 weeks' gestation. Amniotic fluid index was determined using transabdominal ultrasound at admission. All medical records of mothers and neonates were reviewed. Oligohydramnios was defined as amniotic fluid index less or equal to 5.0 cm and latency period was defined as time interval from membrane rupture to delivery. Chi-spuare test, Fisher's exact test, Student-t test, Mann-Whitney U test were used for statistical analysis. RESULTS: 1) Of the 98 patients, 59 patients(60%) were oligohydramnios group(AFI5.0). Both groups were similar with respect to selected dermographics, gestational age at rupture of the membranes, chorioamnionitis, 1 min Apgar score and 5 min Apgar score. Patients with oligohydramnios demonstrated a lower gestatoinal age at birth and lower birth weight. There were no statistically significant correlations in neonatal morbidity and perinatal mortality between both groups. 2) For comparing latency period, we excluded deliveries of Cesarean section or induction. Comparing the remained group(25 patients), median of latency period in oligohydramnios group were 41.5 hours and median of latency period in non-oligohydramnios group were 44 hours. There were no statistically significant correlations in oligohydramnios and latency period. CONCLUSION: There were no significant effects of the oligohydramnios on poor perinatal outcome and latency period in patients with preterm premature rupture of membranes

Transvaginal ultrasonographic detection of fetal abnormalities in the first trimester / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the efficiency of transvaginal ultrasonography for detection of fetal anomalies in first trimester. METHODS: This cohort included pregnant women between 9~14 weeks of gestation from April 2000 to April 2002 at department of Obstetrics and Gynecology, Sanggye Paik hospital, Inje university. Besides ACOG (1993) criteria, we scan nuchal translucency, FHR, cranium, abdominal wall and nuchal lesion using transvaginal sonography. If the anatomical survey was normal, the women underwent routine 18~24 weeks anomaly scans. RESULTS: 20 fetuses were identified as having 21 anomalies. Central nervous system anomaly (38%: 8/21) was the most frequent type of malformation. The other detected anomalies were isolated disorders of the lymphatic system 28% (6/21: two cystic hygromas and four nuchal edema), cystic hygroma associated with hydrops 14% (3/21), abdominal wall defects 14% (3/21), skeletal dysplasia 5% (1/21). Of the 20 fetuses that was diagnosed, 14 patients had elective first-trimester abortion, two had spontaneous fetal deaths, four were delivered at term. CONCLUSION: Besides offering the possibility of early termination, first trimester sonography has the advantage of identifying a transient sonographic sign, nuchal edema, which can be used as a marker in screening for fetal chromosomal abnormalities.