Clinical efficiency of 50 g oral glucose challenge test, 75 g and 100 g oral glucose tolerance test for screening and diagnosis of gestational diabetes / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to compare the clinical efficiency of 75 g oral glucose tolerance test (OGTT) with those of 100 g OGTT for diagnosing gestational diabetes mellitus (GDM) after abnormal 50 g oral glucose challenge test (OGCT). METHODS: Data of 616 pregnant women delivered at Ewha Womans University Dongdaemoon hospital from January, 2003 to June, 2007 was reviewed and analyzed retrospectively. The positive diagnostic rate of GDM for the group resulted in the range of 130 and 140 mg/dl and in 140 mg/dl and higher on the 50 g OGCT group was analyzed. Pregnancy and fetal outcomes were compared for the women who showed positive results in the 75 g and 100 g OGTT. RESULTS: Of the 28 pregnant women whose results were in the range of 130 and 140 mg/dL on the 50 g OGCT, three women (10.7%) were diagnosed as GDM. Among women who showed the results of 140 mg/dL and higher, positive rate of GDM by 75 g OGTT (51.6%) was significantly higher than those by 100 g OGTT (31.6%) (p=0.047). The positive result group of 75 g and 100 g OGTT did not show significant differences in pregnancy and fetal outcomes except that BMI of 100 g OGTT positive group was more increased at early pregnancy (25.2+/-3.53 kg/m2 vs 22.9+/-3.26 kg/m2, p=0.043). CONCLUSION: 75 g OGTT may be a more convenient and useful tool in the diagnosis of GDM to protect for adverse outcomes in untreated gravidas with minimal hyperglycemia.

Tailored selective termination in second trimester in twin pregnancy / 대한산부인과학회지

OBJECTIVE: Recently, selective termination is employed in multifetal pregnancies, in the presence of an abnormal fetus, or in the complication of twin pregnancies. The purpose of this study is to evaluate effectiveness, safety of the tailored selective termination in multifetal pregnancies. METHODS: This study was retrospective and involved six cases. Indication of termination were 3 cases of structural anomalies (anencephaly, encephalocele, body stalk anomaly), 1 case of chromosomal anomaly (21 trisomy) and 2 cases of monochorionic twin complications (acardiac twin, twin to twin transfusion syndrome). RESULTS: We used KCL injection in 4 cases, they were all confirmed dichorionic twin, and in 2 cases of monochorionic twin, we used alcohol ablation of intra-abdominal umbilical artery in 1 case, and radiofrequency ablation of the cord in 1 case. CONCLUSION: All procedures were successful, and all normal infants were delivered in 3rd trimester. Tailored selective termination in 2nd trimester is effective and safe in abnormal multifetal pregnancies.

Effect of Antenatal Dexamethasone Treatment on Neuronal Morphogenesis

BACKGROUND: Glucocorticoids (GCs) are essential for normal development and the maturation of the central nervous system. The aim of this study was to determine the effects of antenatal dexamethasone (DEXA) treatment on neuronal morphogenesis and on the glial cell line-derived neurotrophic factor (GDNF) protein expression in neonatal rat. METHODS: Pregnant Sprague-Dawley rats were injected with saline (the control), or 0.2 mg/kg/day DEXA or 0.8 mg/kg/day DEXA at 17th, 18th and 19th day of gestation. The newborn rat brains were examined at postnatal days 1 (n=75) and 10 (n=78). RESULTS: The DEXA-treated groups showed distorted architectures of neurons in the cerebral cortex, hippocampus and cerebellar cortex at postnatal days 1 and 10 with an increased number of proliferating cell nuclear antigen (PCNA)-positive cells. The cerebellar cortex in the DEXA-treated groups showed delayed development with more PCNA-positive cells in the internal granular cell layer. The Purkinje cells showed a markedly decreased number and the decreased length of the dendritic processes. The GDNF positive reaction was decreased in the DEXA-treated groups in a dose-dependent manner. CONCLUSIONS: The developmental changes and neuronal degeneration at postnatal days 1 and 10 in the newborn rats that were exposed to DEXA at the late gestational age were associated with increased proliferative activity and a decreased level of GDNF protein expression.

Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy / 대한산부인과학회지

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.

Successful Management with Intra-abdominal Alcohol Ablation of Acardiac Twin and Amniodrainage in Twin Reversed Arterial Perfusion Sequence with Severe Polyhydramnios / 대한산부인과학회잡지

Twin reversed arterial perfusion (TRAP) sequence is a unique complication of monochorionic twinning, in which normal pump or donor twin paradoxically perfuses the recipient or acardiac twin through arterial- arterial anastomoses. This results in reversed flow of poorly oxygenated blood through the recipient twin and is usually associated with partial or complete lack of heart development. The pump twin has a mortality rate of 50% as a result of high-output heart failure, preterm labor, and polyhydramnios. We present here a case of twin reversed arterial perfusion (TRAP) sequence complicated by severe polyhydramnios during the second trimester. The blood supply to acardiac twin was interrupted successfully at 25 weeks of gestation by injecting 1.5 mL of absolute alcohol into the intra-abdominal portion of the single umbilical artery, under ultrasound guidance. Serial ultrasound showed normal growth and normal amniotic fluid volume in normal pump twin, but arrest of growth in femur length and decrease in amniotic fluid volume in acardiac twin. The normal pump twin was delivered at 384 weeks of gestation and had uneventful neonatal course.

Synchronous Multiple Primary Malignant Neoplasm Involving the Uterine Endometrium and Ovary / 대한산부인과학회잡지

Multiple primary malignant neoplasm means that more than 2 cancers are independently developed in one individual. In general, the neoplasms are diagnosed simultaneously or within 6 month interval. Simultaneous presentation of carcinomas involving ovary and uterus is not a common event and presents a diagnostic dilemma when they are of the same histology. We experienced a rare case of multiple primary malignant neoplasm involving the uterine endometrium and the ovary synchronously. Thus we report this case with a review of literatures.

Adjuvant Postoperative Radiation Therapy for Carcinoma of the Uterine Cervix / 대한방사선종양학회지

PURPOSE: This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelviclymph node dissection. MATERIALS AND METHODS: Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study.The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, lymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy.All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy.The radiation dose from the external beam to the whole pelvis was 45 50 Gy.Vagina cuffirradiation was performed, after completion of the external beam irradiation, at a low-dose rate of Cs-137, with the total dose of 4488 4932 chy (median:4500 chy)at 5 mm depth from the vagina surface.The median follow-up period was 44 months (15 108 months). RESULTS: The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95%and 94%, respectively.A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002)andparametrial extension (p=0.0001)affected the disease-free survival.From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival.Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients)and lymphedema of the leg (1 patient).No patient had grade 3 or 4 complications. CONCLUSION: Our results indicate that postoperative radiation therapy can achieve good local control and survival rates for patients with stages IB-IIB cervical cancer, treated with a simple hysterectomy, as well as for those treated with a radical hysterectomy, and with unfavorable pathological findings.The prognostic factor for disease-free survival was invasion of the parametrium.The prognostic factor identified in this study for treatment failure can be used as a selection criterion for the combined treatment of radiation and chemotherapy.

A Case of Embryonal Rhabdomyosarcoma Arising from Vaginal wall in a 5 Year Old Child / 대한부인종양콜포스코피학회잡지

Embryonal rhabdomyosarcoma, called sarcoma botryoides, is the most common malignant tumor arising from in the infant vagina. This tumor is diagnosed before the age of 5 and highly malignant. We experienced a case of embryonal rhabdomyosarcoma arising from vaginal wall in 5-year-old girl. Authors presented this case with a brief review of literature.

Comparison of the Clinical Outcomes Between Neoadjuvant Chemotherapy and Radiotherapy Alone in Patient with Cervical Cancer / 대한부인종양콜포스코피학회잡지

PURPOSE: The locoregional failure rate remain high in advanced cervical carcinoma. Chemotherpy(CT) was added to radiotherapy(RT) in order to improve therapeutic result. We performed this study to evaluate the response rate, toxicities and survival benefit of neoadjuvant chemotherapy and to investigate potential role of neoadjuvant chemotherapy in treatment of cervical cancer. METHODS AND MATERIALS: The patients(68 cases of cervical cancer) were divided into two groups ; The one group was neoadjuvant chemotherapy followed by radiotherapy(n=30) and the other was the radiotherapy(n=38) group. The patients were maintained by regular follow-up and evaluated with regards to treatment related toxicity and effectiveness by response using World Health Organization criteria and 5-year survival rate. RESULTS: 30 patients were assigned to receive neoadjuvant chemotherapy. After chemotherpy, the overall clinical response rate was 46.7%. The response rate of neoadjuvant chemotherapy followed radiotherapy was higher than that of the radiotherapy in cervical cancer (100% vs 84.2%). The 5-year survival rate of patients was not different between two groups(p>0.05). Toxicities of chemotherapy were generally tolerable and usually well resolved with conservative treatment. CONCLUSION: Neoadjuvant chemotherapy followed radiotherapy help to improve response rate but did not affect survival benefit in the cervical cancer in this study. However, well controlled long-term prospective study will be need to get firm conclusion.

The Effect of Single Estrogen and Continuous Combined Estrogen + Progestin on Lipid Profile and Bone Mineral Density in Premenopausal Hysterectomised and Natural Menopausal Women / 대한산부인과학회잡지

No abstract available.

Clinical study of the congenital anomalies / 대한산부인과학회잡지

No abstract available.