Doppler assessment of fetal aortic isthmus flow in twin

OBJECTIVE: The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smaller fetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth. METHODS: This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structural or chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within 4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peak systolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistance index (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and was used to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetal growth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins. RESULTS: There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growth discordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantly higher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) and the only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations were found between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). In monochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PI and growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) was found by using logistic regression analyses. CONCLUSION: On the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve the understanding of growth patterns in twins.

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.

Uncommon and Rare Human Papillomavirus Genotypes Relating to Cervical Carcinomas

BACKGROUND: Human papillomavirus (HPV) is an oncogenic virus in cervical cancer and most invasive carcinomas (ICs) are caused by HPV16 and 18. However, the roles and contributions of other uncommon and rare genotypes remain uncertain. METHODS: HPV genotypes were retrospectively assessed using an HPV DNA chip that can specify up to 32 HPV genotypes. We arbitrarily regarded genotypes accounting for less than 6% of the total as uncommon and rare genotypes. RESULTS: A total of 3,164 HPV-positive cases were enrolled. In groups 2A, 2B, 3, and unclassified HPV genotypes, 2.4% of cases with uncommon HPV genotypes (68, 26, 34, 53, 66, 69, 70, 73, 40, 42, 43, 44, 54, 55, 61, 62, 6, and 11) showed high grade squamous intraepithelial lesions and ICs. There were no HPV32- and 57-infected cases. CONCLUSIONS: We found that the uncommon and rare HPV genotypes may provide incremental etiologic contributions in cervical carcinogenesis, especially HPV68, 70, and 53. Further studies on these uncommon and rare HPV genotypes will be of importance in establishing the significance of genotypes in different regions, especially in planning a strategy for further vaccine development as well as follow-up on the effectiveness of the currently used vaccines.

Comparison of birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks / 대한산부인과학회지

OBJECTIVE: The risk of macrosomia in diabetic complicated pregnancy is increased perinatal morbidity. But it is difficult to predict adverse outcomes after birth with conventional diagnostic tools of diabetes in pregnant women. We evaluated the birth-weight between diabetic and non-diabetic pregnant women based on gestational weeks to determine adverse pregnancy outcome. METHODS: We selected 166 diabetic complicated pregnant women delivered between January 2005 and December 2008 and 248 non-diabetic pregnant women at same period. We compared the birth-weight between two groups in relation to the gestational age below and over 37 weeks. Fetal anomalies, fetal death, and multifetal pregnancy were excluded in this study. And we also evaluated the incidence of baby who had birth-weight 3.8 kg or more and their neonatal outcomes between two groups. RESULTS: There were 4.9% (166/3404) of diabetic complicated pregnancies. The preterm births (birth before 37 weeks of gestation) were occurred 32.5% (54/166) and term births (birth after 37 weeks of gestation) were 67.5% (112/166). The mean birth-weight in preterm birth showed 2,492 g of gestational diabetes, 3,315 g of pregestational diabetes and 2,118 g of control group (P=0.001). The mean birth-weight and gestational age at delivery in term birth showed pregestational diabetes and gestational diabetes were heavier and shorter than those of control group (P=0.002). The incidence of 3.8 kg or more of birth-weighted baby appeared 43.5% (10/23) of pregestional diabetes, 16.8% (24/143) of gestational diabetes and 8.5% (21/248) of control group (P=0.000). The Apgar score less than 7 at minutes of neonate were more frequent in pregestational and gestational diabetes than that of control group (P=0.013). CONCLUSION: It is important to classify the type of diabetes during pregnancy and there should be needed to predict adverse pregnancy outcomes including macrosomia.

Differences in Maternal Hair Heavy Metal and Mineral Levels between Preterm Delivery and Full-term Delivery / 대한주산의학회잡지

OBJECTIVES: Previous studies on the effects of heavy metal exposure on adverse birth outcomes are still inconsistent. Heavy metal exposure would be related to decreased birth weight and a shortened gestational age. The aim of this work was to investigate maternal hair heavy metal concentrations in relation to gestational age at delivery. METHODS: A total of 52 maternal hair samples were collected at the department of Obstetrics and Gynecology, Gil hospital, Korea. Delivery before 37 weeks of gestation was defined as preterm and delivery after 37 weeks of gestation was defined as full-term delivery. We gathered the specimens from maternal hair approaching delivery. 23 samples were taken from preterm delivered mothers and 29 samples from full term delivered mothers. We evaluated maternal specimen by hair tissue mineral analysis to measure heavy metal concentrations accumulated for more than several months. All statistical analyses were performed with Chi-square test, Mann-Whitney U test and Wilcoxon W test. RESULTS: Heavy metal was revealed in pregnant women's hair but there was not a significant correlation between levels of heavy metal and gestational age at delivery. Compared numbers of preterm delivery and full-term delivery by stratified by heavy metal concentrations did not have significant correlation. CONCLUSIONS: This study does not show any strong relationship between delivery outcome and heavy metal measured by hair tissue mineral analysis. Further prospective studies with serial measures of cord blood heavy metal level and hair its levels may be required.

Expression of Heat Shock Protein 60 kDa Is Upregulated in Cervical Cancer

PURPOSE: Cervical cancer caused by the human papilloma virus (HPV) continues to be the cause of yearly death among women. However, it is a curable disease when diagnosed at an early stage. Recently, several researches have reported that heat shock protein (HSP) 60, a chaperone protein of molecular weight of 60 kDa, is involved in carcinogenesis and apoptosis. In order to evaluate the prognostic significance of HSP60 in cervical cancer, we examined differences in the HSP60 expression between cervical cancer and normal tissues in women. MATERIALS AND METHODS: Tissue samples were collected from 20 cervical cancer patients and 20 normal controls. HSP60 expression of cervical cancer and normal tissues were verified by the 2D gel proteomics, semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot analyses. RESULTS: In 2D proteomic analysis, an increase of HSP60 expression was detected in cervical cancer tissues and confirmed by Western blot analysis (p < 0.05). However, messenger RNA (mRNA) levels of HSP60 did not display any significant differences between cervical cancer and normal tissues. CONCLUSION: These results suggest that HSP60 may be involved in the development of cervical cancer and have profound biological and prognostic significance.

The Effects of Maternal Age on Outcome of Pregnancy in Healthy Elderly Primipara / 대한주산의학회잡지

PURPOSE:To investigate the pregnancy outcomes associated with delayed first childbearing METHODS:We evaluated retrospectively the clinical characteristics and pregnancy outcomes in primiparous mothers who delivered a fetus after more than 21 weeks of gestation in our hospital from January 2001 to December 2008. We enrolled only healthy primiparous mothers who have no underlying cardiovascular disease, hypertensive disorders complicating pregnancy and overt or gestational diabetes to remove the confounding factors which influence the pregnancy outcomes. Finally, 235 mothers aged 35 years and above and 1571 mothers aged 20~34 years were included in the study and the control groups, respectively. RESULTS:There were no differences in gestational age and birth weight between two groups. There was significantly higher incidence of cesarean section in the study group. (60.4% vs 39.4%, P= 0.000) The incidence of previous uterine operation history and placenta previa which were the indications of cesarean section were higher in the study group (3.0% vs 0.2%, P=0.000, 9.4% vs 5.2%, P=0.011). Antepartum and postpartum complications with the significantly higher incidence rates in study group were placenta previa and uterine myoma (6.0% vs 2.8%, P=0.010, 4.7% vs 1.2%, P=0.000) and wound complications (1.7% vs 0.3%, P=0.005), respectively. On the other hand, the neonatal outcomes and other antepartum/postpartum complications, such as the incidence of preterm labor, PROM and postpartum bleeding, of two groups were comparable (no significant differences were noted). CONCLUSION:Although incidence of placenta previa, cesarean section, uterine myoma and wound complication were higher in healthy old primiparous mothers, no differences were noted in neonatal outcomes compared to the young primiparous mothers. We conclude that elderly primiparous pregnancy in woman should not be considered as a high risk pregnancy on the basis of age alone.

Prenatal ultrasonographic diagnosis of thoracoabdominal cavernous lymphangioma: A case report / 대한산부인과학회지

Lymphangiomas are congenital anomalies of the lymphatic system in which abnormal lymphatic channels are localized to form a benign mass. Lymphangiomas are classified into 3 types: simple, cavernous, and cystic (=cystic hygroma). Mixed forms may coexist. Cavernous lymphangiomas are very rare variants and characterized by penetration through the subcutaneous area between the muscular septa. Lymphangiomas are typically presented in the head, neck and axillary region, while cavernous lymphangiomas most commonly occur in the thorax or retroperitoneum. Although there are many papers about the cystic hygroma, a few cases of fetal thoracoabdominal cavernous lymphangioma have been reported. Accurate prenatal diagnosis and anatomical evaluation are important for delivery planning and prompt postnatal resuscitation. The anomaly was assessed by two dimensional (2D), three dimensional (3D), and real-time multiplanar four dimensional (4D) ultrasound. This case report confirms the usefulness of the 3D, real-time multiplanar 4D ultrasound to assess the mass extension and relationship with adjacent structures. We present a case of fetal thoracoabdominal cavernous lymphangioma diagnosed by 2D, 3D, real-time multiplanar 4D ultrasound with brief review of literatures.

The association between adverse pregnancy outcomes and the serum inhibin A levels in mid-trimester of gestation / 대한산부인과학회지

OBJECTIVES: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. METHODS: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. RESULTS: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. CONCLUSIONS: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.

Effect of weight gain during the pregnancy on success of vaginal birth after cesarean delivery (VBAC) / 대한주산의학회잡지

PURPOSE: To examine the relationship between weight gain and the success of VBAC by using body mass index (BMI). To examine the relationship between weight gain and the success of VBAC by using body mass index (BMI). METHODS: The study compared clinical features taken from 112 patients who tried VBAC at our institute from January 2001 through December 2006. There were divided into two GROUPS: 92 patients for the success (82.1%) and 20 patients for the failure group (17.9%). Excluding 36 patients with no BMI data, we constructed Receive-operating characteristics (ROC) curve to make the optimum BMI value for the prediction of success of VBAC. Based on the BMI 26 or more, two groups of patient were surveyed the interrelation between weight gain and success of VBAC. RESULTS: Between success and failure group, the weight gain during pregnancy showed significant differences which are 11.2+/-4 kg of the success group and 13.2+/-5 kg of the other one (p<0.05) A survey on the availability of the BMI date to estimate success of VBAC, the criteria with the standard BMI 26 is not statistically valuable (p=0.837). By comparing normal weight and overweight based on BMI 26, some factors showed statistically significant discrepancies: number of prenatal visit, maternal weight gain, maternal weight at the time of delivery, use of oxytocin and birth weight. CONCLUSION: BMI value of 26 has limitations in using as an estimate criteria on success of VBAC. Patients, however, who had relatively small scale of weight gain, showed significant clinical factors to increased success rate of VBAC.

A study on the clinical characteristics of emergency peripartum hysterectomy / 대한주산의학회잡지

OBJECTIVE: To investigate the clinical characteristics and associated risk factors for emergency peripartum hysterectomy classified by the amounts of blood loss. MATERIAL AND METHODS: We reviewed the medical records of 159 cases of peripartum hysterectomy among 46,666 deliveries, from Jan. 1995 to Dec. 2005 at the Dept. of Ob. & Gy. of Graduate School of Medicine, Gachon University of Medicine and Science. We divided the 159 cases into three groups based on the amounts of blood loss, which were group A as less than 2,000 mL of blood loss, group B as 2,000 to 4,000 mL of blood loss, and group C as more than 4,000 mL. The incidence, the type of delivery, the amounts of transfusion, the operative indication and the complications of peripartum hysterectomy were evaluated. RESULTS: The incidence of peripartum hysterectomy was 0.34% (159/46,666) and 0.47% in cases of cesarean section and 0.19% in vaginal delivery, respectively. There was no meaningful correlation between maternal age, parity, gestational age, hospital stay and amount of blood loss. The increments of blood loss correlated to the frequency of peripartum hysterectomy after cesarean section (p<0.05). The most common operative indication in group A was uterine atony (47.19%), and those in group B and C were adherent placentation (48.08%, 50.00%). Intraoperative and postoperative complications according to excessive bleeding were increased, and DIC, pulmonary infection, urethral and bladder injury were observed more frequently in group C than in group A. CONCLUSION: The emergency peripartum hysterectomy was related to adherent placentation and was accompanied with increased blood loss.

Telomerase and Apoptosis in the Placental Trophoblasts of Growth Discordant Twins

In an effort to investigate the molecular basis of growth discordance in embryos that experience the same uterine environment, we compared telomerase activity and apoptosis in placental trophoblasts obtained from growth discordant twins. Between January 2003 and February 2005, placental tissue from twenty pairs of twins was obtained within thirty minutes of delivery. Eleven cases were classified as growth discordant, with birth weight discordance greater than 20%. Nine cases comprised the control group, with less than 20% discordance. Telomerase and apoptotic activities in placental trophoblasts were analyzed by ELISA and immunoblot. Statistical significance was analyzed by a paired t-test, chi- squared test, and ANOVA (SPSS ver 11.0). The average growth discordance was 26.8% in the growth discordant group and 14.4% in the control group. There were no significant differences in maternal age, week of gestation at delivery, parity, or chorionisity between the two groups. In the growth discordant group, the larger twin showed significantly higher telomerase activity (p < 0.01), whereas no significant difference was observed in the control group (p = 0.36). In addition, there was no definitive correlation between telomerase activity and the degree of growth discordance in the larger or smaller twins (R = -0.521 and -0.399, p = 0.15 and 0.25, respectively). The apoptosis proteins Bax and Bcl 2 were detected in both the larger and smaller twins in the growth discordant and control groups. There was no statistically significant difference in Bax expression between the larger and smaller twins (p = 0.25 and 0.92, respectively) for either the growth discordant or the control groups. Bcl 2 expression also showed no significant difference between groups. In Conclusion, A tendency toward reduced telomerase activity and increased apoptosis was discovered in placental trophoblasts of the smaller growth- discordant twin, possibility resulting in delayed fetal growth.

Surgical approaches for gynecologic malignancies causing peritoneal dissemination / 대한산부인과학회지

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

A Clinical Study on 570 Cases of Laparoscopy Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcome and characteristics of laparoscopy assisted vaginal hysterectomy (LAVH) in gynecologic patients. METHODS: From September, 2001 to February, 2004, total 570 cases of patients were performed LAVH at Gacheon medical school Ghil Hospital. We reviewed medical records and analyzed these cases about age, parity, weight, previous surgery history, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: The results of this study summarized as follows. The mean age of patients was 46.4 +/- 7.2 years old. Average parity of patients was 2.4 +/- 1.4. Average weight of patients was 63.4 +/- 8.2 kg. Previous operation history was 195 cases (34.2%). Most common operation indication was uterine leiomyoma, followed by adenomyosis, combination of leiomyoma and adenomyosis and endometriosis. The mean operation time was 72 +/- 20.6 minutes. The mean duration of hospitalization was 4.5 +/- 0.6 days. The major complication of operation was trocar site bleeding, followed by bladder injury, bowel injury, and ureteral injury. CONCLUSION: LAVH is safe and useful. So it is recommendable to gynecologic patients.

Minilaparotomically Assisted Vaginal Hysterectomy

Endoscopic hysterectomy is increasingly selected as a current trend to minimize invasion, tissue trauma and early recovery. However it has disadvantages of the difficulty to learn and needs expensive equipments. So we developed a new minimally invasive method of vaginal hysterectomy-minilaparotomically assisted vaginal hysterectomy (MAVH) in order to complement the current laparoscopic surgery. The principle of MAVH is based on suprapubic minilaparotomical incision and uterine elevator that allows access and maximal exposure of the pelvic anatomy and an easy approach to the surrounding anatomy enabling division of round ligaments, Fallopian tubes, tuboovarian ligaments, and dissection of bladder peritoneum. After then, the vaginal phase of MAVH is done by the traditional vaginal hysterectomy. We enrolled 75 consecutive cases and in 73 cases thereof MAVH was accomplished successfully. The technique of MAVH is simple and easy to learn and it involves a small incision causing less pain and complications. This practice does not require expensive equipments. MAVH is considered as a safe and effective alternative method for abdominal hysterectomy in most cases.

A Clinical Study of Pregnancy and Delivery in Women Aged 40 Years and Older / 대한산부인과학회잡지

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.

A clinico-pathological analysis of microinvasive cervical cancer / 대한산부인과학회잡지

OBJECTIVE: To evaluate correlation the of histological variables and the clinical features of microinvasive cervical cancer with the depth of invasion and to establish the adequate therapeutic modality. METHODS: One hundred and thirty-seven patients with microinvasive cervical cancer diagnosed by FIGO (1994) staging were reviewed, who were treated by conization, type I hysterectomy, type II hysterectomy and type III hysterectomy, in Gil Medical center from January 1997 to December 2001. We divided the depth of invasion to three groups of less than 1 mm, 1-3 mm and 3-5 mm. RESULTS: The age of the 137 women ranged from 24 to 71 years (mean age 47.4 years). The number of patients with FIGO stage IA1 and IA2 were 112 and 24, respectively. Of surgically treated 135 patients, lymph node involvement was present in 1 patient with a depth of invasion of less than 1 mm, 2 patients with 1-3 mm and 1 patient with 3-5 mm. Lymph-vascular space involvement was present in 3 patients with 1-3 mm, 4 patients with 3-5 mm. Transient bladder dysfunction was the most common complication after surgical procedures, occupying 5.6%. Other surgical complications included lymphedema (3.6%), wound complication (3.6%), ureter injury (1.1%), lymphocele (1.1%), anal incontinence (1.1%) and dyspareunia (1.1%). CONCLUSION: A management should be individualized. Patients with a depth of invasion of less than 1mm and clear resection margin may be managed by conization. Further follow-up study for a necessity of lymphadenectomy for the group with the depth of invasion of 1-3 mm irrespective of lymph-vascular space involvement is demanded.

Minilaparotomically Assisted Vaginal Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: To review the safety and effectiveness of a new vaginal hysterectomy method, Minilaparatomically Assisted Vaginal Hysterectomy (MAVH), tried on benign diseases with indication of abdominal hysterectomy. MATERIALS AND METHODS: The analysis of the safety and the effectiveness of MAVH is based on randomized consecutive 75 patients who received the operation from Feb. 1, 2002 to Jul. 10, 2002 in the department of Obstetrics and Gynecology at Gacheon Medical University Hospital. OPERATION TECHNIQUE: Access to the pelvic cavity was obtained by the traditional suprapubic minilaparotomical incision that is 2-2.5 cm long and parallel to the pubic hair line. Through this incision site, the adnexa and other pelvic organs around the bladder were brought into sight by manipulating the uterine elevator that was already inserted into the uterine cavity. By this method, the round ligament, uteroovarian ligament, and the fallopian tube were exposed at the incision site, then clamped, cut, sutured and divided. The dissection of the bladder peritoneum was performed and then followed by the traditional transvaginal approach. RESULTS: The MAVH was successful in 73 cases (97.3%) out of 75 attempts. The mean age, parity, weight, and body mass index of the subjects of the 73 cases were 42.6 (+/-7.8) years, 2.0 (+/-0.7), 59.5 (+/-7.5) kg, and 23.6 (+/-2.6). Forty subjects (54.8%) had a previous surgical history. The operational indications were 44 cases (60.3%) of uterine myoma, 19 cases (26.0%) of uterine bleeding, 7 cases (9.6%) of dysmenorrhea, and 3 other cases (4.1%). There were 6 cases (8.2%) of cumulative complication. In terms of pathologic diagnosis, 54 cases (74.0%) were uterine myoma with adenomyosis, 12 cases (16.4%) adenomyosis, 2 cases (2.7%) endometrial polyp, 1 case (1.4%) endometrial hyperplasia, 1 case endometrial cancer, and 3 other cases. The weights of uteri ranged from 75 gm to 1150 gm with an average of 286.8 (+/-217.5) gm. The average operation time for MAVH from skin incision to the completion of suture was 75.8 (+/-21.8) minutes. The average bowel function recovery time was 45.9 (+/-12.9) hours. The external bleeding loss was 337.0 (+/-306.8) ml, 11.0% (8/73) required transfusion with an average amount of 1.5 pint. No subject of this study needed reoperation or expired. CONCLUSION: The technique of MAVH is simple and easy to learn. The MAVH involves a relatively small size of incision and less pain and complication with fast recovery and small wound. The method requires a little bit of practice but not an expensive equipment. The MAVH is considered as a safe and effective operational method which could replace the abdominal hysterectomy in most cases.

Prenatally Diagnosed Anterior Abdominal Wall Defects / 대한산부인과학회잡지

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.

Clinical Analysis of Atypical Glandular Cells of Undetermined Significance (AGUS) on Pap Smear according to Menopausal Status / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.