White blood cell differential count and adnexal mass size may predict potential malignancies in laparoscopic surgery / 대한산부인과내시경학회지

OBJECTIVE: We investigated the clinical value of using preoperative differential white blood cell (WBC) count to predict the potential for malignancy of adnexal masses in laparoscopic surgery. METHODS: The electronic medical records of 1325 patients who underwent laparoscopic surgery for adnexal masses between July 2005 and December 2008 were analyzed retrospectively. RESULTS: Of 1325 patients, 30 (2.3%) had adnexal masses with malignant potential. Analysis of differential WBC count, neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), serum CA 125, mass size showed that only cyst size was significantly different between patients with potentially malignant adnexal masses, those with benign disease (averages of 9.45 cm vs. 6.23 cm, p=0.001). Further analysis was performed using a combination of various markers and multiplication of cyst size and NMR yielded the highest area under the curve, at 0.711(95% confidential interval 0.619~0.806, p<0.001), with a sensitivity and specificity of 86.7% and 48.3% respectively, at a cut off value of 67.23. These values were also significantly different between patients with potentially malignant adnexal masses, and dermoid cyst or endometrioma (p=0.038 and 0.002 respectively, by analysis of variance, post hoc test). CONCLUSION: Preoperative measurement of NMR in conjunction with cyst size may be used as a simple, non invasive marker for predicting the malignant potential of adnexal masses before laparoscopic surgery.

Comparison of Factors Which Influence the Brachial-Ankle Pulse Wave Velocity in Pre- and Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The aim of this study was to compare the factors which influence the brachial-ankle pulse wave velocity (baPWV) in pre- and post-menopausal women. We also investigated the association of menopause with arterial stiffness measured by baPWV. METHODS: We performed a retrospective review of 241 postmenopausal women who attended the health promotion center for a routine checkup. Simple and multiple regression analyses were performed to determine the parameters influencing baPWV in pre- and postmenopausal women. Multiple logistic regression analysis was performed to identify the independent parameters related to increased of arterial stiffness. RESULTS: Multiple regression analysis showed that diastolic blood pressure (DBP; beta = 0.402, P = 0.009) was identified as an independent determinant for baPWV in premenopausal women, and DBP (beta = 0.329, P = 0.021) and the neutrophil-to-lymphocyte ratio (NLR; beta = 0.210, P = 0.016) were identified as independent determinants for baPWV in postmenopausal women. The odds ratio (95% CI) of menopause for a high baPWV was 2.666 (1.025~6.937). CONCLUSION: The NLR is associated with arterial stiffness in postmenopausal women. Consequently, inflammation is thought to play a crucial role in increased arterial stiffness in postmenopausal women. Menopause is associated with a high baPWV, suggesting that changes in the concentrations of sex hormones during the menopausal transition may influence arterial stiffness in clinically healthy women.

Comparison of Factors Which Influence the Brachial-Ankle Pulse Wave Velocity in Pre- and Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The aim of this study was to compare the factors which influence the brachial-ankle pulse wave velocity (baPWV) in pre- and post-menopausal women. We also investigated the association of menopause with arterial stiffness measured by baPWV. METHODS: We performed a retrospective review of 241 postmenopausal women who attended the health promotion center for a routine checkup. Simple and multiple regression analyses were performed to determine the parameters influencing baPWV in pre- and postmenopausal women. Multiple logistic regression analysis was performed to identify the independent parameters related to increased of arterial stiffness. RESULTS: Multiple regression analysis showed that diastolic blood pressure (DBP; beta = 0.402, P = 0.009) was identified as an independent determinant for baPWV in premenopausal women, and DBP (beta = 0.329, P = 0.021) and the neutrophil-to-lymphocyte ratio (NLR; beta = 0.210, P = 0.016) were identified as independent determinants for baPWV in postmenopausal women. The odds ratio (95% CI) of menopause for a high baPWV was 2.666 (1.025~6.937). CONCLUSION: The NLR is associated with arterial stiffness in postmenopausal women. Consequently, inflammation is thought to play a crucial role in increased arterial stiffness in postmenopausal women. Menopause is associated with a high baPWV, suggesting that changes in the concentrations of sex hormones during the menopausal transition may influence arterial stiffness in clinically healthy women.

Comparison between tension-free vaginal tape (TVT) and transobturator tape (TOT) with concomitant surgery for pelvic organ prolapse / 대한산부인과학회지

OBJECTIVE: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). METHODS: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student's t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. RESULTS: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91+/-0.93 g/dL; TOT, 1.53+/-0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. CONCLUSION: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications.

Prognostic factors for predicting spontaneous pregnancy after laparoscopic surgical treatment of endometriosis / 대한산부인과학회지

OBJECTIVE: To identify the prognostic factors for predicting spontaneous pregnancy after laparoscopic surgical treatment of endometriosis. METHODS: Retrospective analysis was performed in 82 patients who underwent elective laparoscopic surgery with subsequent pathological confirmation of the endometriosis at Gangnam Severance Hospital from January 2003 to March 2008. We investigated the spontaneous pregnancy rate during the 12 months following surgical treatment and administration of Gonadotropin-Releasing Hormone agonist (GnRH agonist). Factors associated with clinical characteristics, blood tests and operative findings were compared with pregnant and non-pregnant women. RESULTS: The number of patients succeed to spontaneous pregnancy was 32 and failed to pregnancy was 50. Cumulative pregnancy rate was 39.02%. Mean pregnancy duration after surgical treatment was 5.96+/-3.43 months. r-AFS stage or grouping into two stages (mild/severe) (P=0.018), r-AFS score (P=0.008) and cul-de-sac obliteration (P=0.038) was significantly different between pregnant and non-pregnant group. Complete cul-de-sac obliteration was the independent factor of pregnancy failure in women with endometriosis after laparoscopic surgery. CONCLUSION: Complete cul-de-sac obliteration may be the important factors for predicting spontaneous pregnancy outcome in women with endometriosis after laparoscopic surgical treatment.

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

PURPOSE: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse > or = stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

A case of ultrasound-guided cyst aspiration and sclerotherapy for the management of intractable pelvic pseudocyst / 대한산부인과학회지

Patients who underwent laparotomy often experience recurrent pelvic pseudocysts and they may need to undergo another laparotomy. Nowadays, many less invasive techniques such as the use of ultrasound-guided aspiration of pelvic pseudocysts and sclerotherapy were developed and were replacing laparotomy. We report a case of intractable pelvic pseudocyst treated successfully with ultrasound-guided cyst aspiration and sclerotherapy using acetic acid with a brief review of literature.