Leukocytes and lactobacilli of vaginal discharge as a predictor of pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate whether the vaginal polymorphonuclear leukocytes and few lactobacilli on microscopic evaluation of a saline wet preparations would be associated with pelvic inflammatory disease (PID) in Korean women. MATERIALS AND METHODS: We performed a cross-sectional study of 556 women between 16 and 78yrs of age from May 2001 to May 2003. Wet-mount microscopic examination of vaginal discharge was done on all patients. Positive vaginal polymorphonuclear leukocytes was defined as more than 10 white blood cells per high-power field on microscopic examination, and few lactobacilli was defined as less than 30 per high-power field on microscopic examination. The diagnosis of PID was relied on the minimal criteria delineated by the Centers for Disease Contral and Prevention, elevated CRP or ESR and positive anaerobic cultures. RESULTS: On univariate analysis, positive vaginal polymorphonuclear leukocytes and few lactobacilli were associated with PID, but age (less than 25) and marital status were not. On multivariate analysis using multiple logistic regression, odds ratios of positive vaginal polymorphonuclear leukocytes and few lactobacilli for PID were 5.995 (95%CI: 3.056-11.761) and 24.39 (95%CI: 10.989-55.556) respectively. The sensitivity and negative predictive value of positive vaginal polymorphonuclear leukocytes or few bacilli for predicting PID were 90.6% and 94.42% respectively. CONCLUSION: Positive vaginal polymorphonuclear leukocytes and few lactobacilli were strongly associated with PID. Positive vaginal polymorphonuclear leukocytes and few lactobacilli have a high sensitivity and negative predictive value for predicting PID. Therefore the existence of vaginal polymorphonuclear leukocytes and few lactobacilli are thought hereafter to be useful marker to diagnose PID.

A comparison of the effect of Anastrozole and Clomiphene citrate in anovulatory patients / 대한산부인과학회지

OBJECTIVE: To compare the clinical effectiveness of Anastrozole in ovulation induction with that of clomiphene citrate. METHODS: Sixty anovulatory women were randomly divided into 4 groups (1 mg, 2 mg and 4 mg of Anastrozole groups and Clomiphene citrate group). The ovulation induction was tried with 3 dosages of Anastrozole or 100 mg of Clomiphene citrate for 5 days. The serum level of estradiol, testosterone, FSH and LH were serially monitored (on 3rd, 5th and 8th days of treatment). Serum estradiol level at the time of hCG injection was also measured. Ovulation rate, number of dominant follicles, endometrial thickness, and pregnancy rate were measured and compared across the study groups. RESULTS: There was no statistically significant difference in estradiol, testosterone, or LH level between women treated with Anastrozole and Clomiphene citrate. In patients treated with 4 mg of Anastrozole, serum FSH level was higher than that of the women treated with Clomiphene citrate (P<0.05). Endometrial thickness was greater in patients treated with Anastrozole than women treated with Clomiphene citrate (P<0.05). Number of dominant follicles in patients treated with Clomiphene (1.56) was slightly greater than in women treated with Anastrozole (1.0-1.1), but there was no statistically significant difference. CONCLUSION: Anastrozole had similar clinical effectiveness in ovulation induction when compared to Clomiphene citrate. At 1 mg or 2 mg of Anastrozole, ovulatory rate remained below the effectiveness of Clomiphene citrate, therefore considering the expensive cost of Anastrozole, it should not be considered as first-line medication for ovulation induction but reserved for those who have certain conditions such as thin endometrium and polycystic ovarian syndrome.

Clinical Consideration on the Method of Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The most common operation in gynecology is hysterectomy. To compare the indications, patient characteristics and clinical outcome, complication between total abdominal hysterectomy (TAH) and vaginal total hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: This study was designed to analyze 147 patients of TAH (Group I) from January 2003 to September 2003, 48 patients of TVH (Group II), 108 patients of LAVH (Group III) at Eulji medical center of obstetrics and gynecology from January 2002 to September 2003. We analyzed the result with patient characteristics, parity, medical disease, history of previous operation, indication of hysterectomy, uterine weight, concurrent surgical procedure, operation time, bleeding amount, complication and length of hospital stay. Uterine prolapse was excluded in the analysis of this study. RESULTS: Patient characteristics, parity, medical disease were no differences. Number of previous operation were 63 cases (42.9%) in TAH group, 10 cases (20.8%) in TVH group, 43 cases (39.8%) in LAVH group, and the most common of operation was tubal ligation in three gropups. Most common indication of hysterectomy was uterine leiomyoma. The mean uterine weight was 374.31 +/- 250.26 gm in TAH group, 187.70 +/- 109.62 gm in TVH group and 203.26 +/- 94.92 gm in LAVH group. The mean operation time was 89.61 +/- 25.24 min in TAH group, 73.39 +/- 21.80 min in TVH group and 96.18 +/- 27.98 min in LAVH group. Postoperative complication was observed 60 cases (40.8%) in TAH group, 8 cases (16.7%) in TVH group, 19 cases (17.6%) in LAVH group. Most common complication was bleeding and required transfusion (TAH 32 cases (21.8%), TVH 3 cases (6.3%), LAVH 10 cases (9.3%)). CONCLUSION: LAVH and TVH present superior result in terms of complication when compared with TAH. LAVH and TVH have advantage of lower morbidity, less pain, shorter hospital stay and convalescence. LAVH should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.