Clinical efficacy of photodynamic therapy

OBJECTIVE: The management of cervical intraepithelial neoplasia (CIN) and early invasive cancer of the uterine cervix is very difficult to approach, especially in case of young woman who wants to preserve her fertility. Conization of the cervix may have various kinds of disadvantage. The objective of this clinical retrospective study is to investigate the therapeutic effects and clinical efficacy of photodynamic therapy (PDT) including combined chemo-photodynamic therapy in patients with pre-malignant CIN and malignant invasive cervical cancer. METHODS: Total number of PDT trial case was 50 cases and total number of patient was 22 patients who registered to PDT clinic. We used photogem sensitizer and 632 nm diode laser in early two cases. After then we performed PDT using photofrin sensitizer and 630 nm diode laser in other cases. We used flat-cut, microlens, cylindrical diffuser, and interstitial type optic fibers in order to irradiate the lesions. 240 J/cm² energy was irradiated to the lesions. RESULTS: CIN 2 were 4 cases (18.2%) and CIN 3 were 15 (68.2%) and invasive cervical cancer were 3 (13.6%). Complete remission (CR) was found in 20 patients (91%). One case of 19 patients with CIN lesion recurred at 18 months after PDT treatment. CR was found in 18 cases in the patients with CIN lesions (95%). CR was found in 2 cases in the patients with invasive cervical cancer (67%). CONCLUSION: Our data showed that CR rate was fantastic in CIN group (95%). This study suggests that PDT can be recommended as new optimistic management modality on the patients with pre-malignant CIN lesions including carcinoma in situ and relatively early invasive cancer of the uterine cervix. Combined chemo-photodynamic therapy is essential in case of invasive cervical cancer. For the young age group who desperately want to preserve their fertility and have a healthy baby, PDT can be a beacon of hope.

Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

Spontaneous Uterine Rupture during Second Trimester Pregnancy after High-intensity Focused Ultrasound / 대한주산의학회잡지

Uterine rupture during pregnancy does not occur frequently, but is associated with high rates of maternal and perinatal morbidity and mortality. As a non-invasive and conservative approach, high-intensity focused ultrasound (HIFU) has received attention from both gynecologists and patients for the treatment of fibroids, especially women who wish to preserve uterus. However, there are not enough studies about complication and prognosis related pregnancy after HIFU. We present a case of uterine rupture that occurred in second trimester who had been HIFU 3months before pregnancy.

A survey on the education, medical practice, research, and fringe benefits of Korean medical school faculty

In general, medical school faculty have to perform clinical practice in addition to their educational and research activities, unlike the professors of other departments, while simultaneously playing an important role within the medical profession. However, some organizational or environmental factors decrease the job satisfaction of medical professors. This study aimed to determine the current status of medical schools professors' job activities, satisfaction level, factors related to job satisfaction, and so on. A structured questionnaire was used in the survey and 936 valid responses (response rate, 79.1%) were analyzed using SAS version 9.1. Items included in the questionnaire were work tasks, satisfaction with work and environment, fringe benefits, and future plans. Our study found that the satisfaction of respondents with research activities was not high, and they had negative perceptions of their work environment. Also, it was found that job satisfaction was most affected by work environment. In the section on fringe benefits, a variety of fringe benefits were provided to respondents but their actual satisfaction was not high. To enhance the overall job satisfaction of medical school faculty, all the matters related to their work tasks and environmental factors have to be considered in the aspect of their own role in medical school. The limitations of this study were a low response rate to the early online survey and a long duration of the survey period. However, these limitations were resolved by an additional mail survey modality and statistical techniques. It is meaningful that this study was an extensive survey aimed at medical school faculty and dealt with a comprehensive range of issues.

Photodynamic therapy using topically applied 5-aminolevulinic acid for treatment of cervical cancer / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the treatment effects of a topical application of 5-aminolevulinic acid (5-ALA) for photodynamic therapy (PDT) to treat cervical cancer. METHODS: We first investigated the effects of 5-ALA cream according to application time. And to find the effective 5-ALA concentration and the distribution times in vivo, 20% 5-ALA cream was topically applied to the tumor of the nude mouse. We then observed the distribution of 5-ALA via fluorescence measurement with using a 532 nm diode laser. 25 nude mice were divided into Control, ALA, Laser, and PDT group. To evaluate the PDT effect at cancer lesion, we applied 20% 5-ALA cream to the tumor by the same method, and the PDT was done by using a 632 nm diode laser at the time of the peak level of fluorescence. We checked the changes of the volume of cancer for 30 days, and then biopsy was done. RESULTS: The effective post-irradiation time after topical ALA application was 9 hours. In the PDT group, 40% (4/10) of the mice showed decreased tumor size. CONCLUSION: The maximum PpIX fluorescence at 9 hours after local applicationof 5-ALA cream was checked. And PDT group did not show any statistical difference than control group in the growth of tumor size than control group. However responding cases (4/10) of PDT group showed the meaningful decrease of tumor size than control group (P<0.05).

Detection of human papillomavirus type 16 and 18 by PCR in patients with cervical neoplasia / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the detection rate of human papillomavirus (HPV) DNA Test (type 16 and 18) and to investigate the clinical significance of HPV DNA test in patients with cervical neoplasia. METHODS: Of the 708 patients aged 21~83 years who had undergone both conventional Papanicolaou cervical cytologic test and HPV DNA test by polymerase chain reaction, 383 cases underwent histologic diagnoses. RESULTS: Of the 708 cytologic diagnoses, there were 11 positive HPV DNA test diagnoses in squamous cell carcinoma (SCC), 41 in high-grade squamous intraepithelial lesion (HSIL), 20 in low-grade squamous intraepithelial lesion (LSIL), 41 in atypical squamous cells (ASC), and 86 in negative cytology. Of the 383 histologic diagnoses, there were 24 positive HPV DNA test diagnoses in SCC, 42 in cervical intraepithelial neoplasia (CIN) 3, 12 in CIN 2, 12 in CIN 1, 7 in atypical change, and 45 in negative histology. Of the 239 patients with negative HPV DNA test, 28.5% cases showed histologic diagnoses of CIN 1 or worse lesion. Of the 46 patients with negative cytology and positive HPV DNA test, 50.0% cases showed histologic dianoses of CIN 1 or worse lesion. Pap cytology revealed sensitivity of 72.5%, specificity of 66.4%, and false negative rate of 27.5%, whereas HPV DNA test showed 57.5%, 76.7%, and 42.5%, respectively. CONCLUSION: This study confirmed that the primary standard Pap cytology and HPV DNA test were adjunctive. Also this study showed that physicians always should not overrate Pap cytology or HPV DNA test in managing the patient with cervical neoplasia. Combined test was a very effective diagnostic method for detecting cervical neoplasia.

The anticancer effect and mechanism of photodynamic therapy using a new photosensitizer and diode laser on cervical cancer cell / 대한산부인과학회지

OBJECTIVE: During the last several years, such as Photofrin(R), Photogem(R), HpD, and 5-aminolevulenic acid (ALA) has been used as photosensitizers for a wide range of malignant tumors as well as non-malignant disease. A new photosensitizer, 9-Hydroxypheophorbide-a (9-HpbD-a) was derived from Spirulina platensis. The aim of this study was to evaluate the anticancer effect and mechanism of photodynamic therapy in vitro using 9-HpbD-a and 670 nm diode laser on a HT-3 cervical cancer cell line. METHODS: We studied the cytotoxic effect of 9-HpbD-a and 670 nm diode laser in HT-3 cervical cancer cell line. The cultured HT-3 cells were treated with serial concentrations of 9-HpbD-a followed by various irradiation time (0, 5, 15, 30 min) and by various interval times (0, 3, 6, 9, 12 24 hours) until laser irradiation, then 3- (4,5-dimethylthiazol-2-yl) -2,5-diphenyl-tetrazolium bromide (MTT) assay was applied to measure the relative inhibitory effect of PDT. RESULTS: Optimal condition for laser irradiation time was 15 minutes and the cytotoxic effect according to the incubation time after 9-HpbD-a treatment was increased until 6 hours. Under confocal microscopy, to observe intracellular localization of 9-HpbD-a, cells dual-stained with 9-HpbD-a and panel of organelle-specific fluorescence probes (MitoTracker, LysoTracker, ER-Tracker), endoplasmic reticulum (ER) as a major accumulation organelle site in HT-3 cervical cell line for this new photosensitizer. CONCLUSION: The anticancer effect of PDT using 9-HpbD-a is effective in HT-3 cervical cancer cell line. This agent therefore represents a promising photosensitizing prodrug for the treatment of cervical cancer with PDT in clinical setting for the future.

Anti-Yo-associated paraneoplastic cerebellar degeneration in a patient with chemotherapy-responsive ovarian cancer: A case report with a review of literatures / 대한산부인과학회지

Paraneoplastic cerebellar degeneration (PCD), the one of rare paraneoplastic syndromes, refer to clinical disorders associated mostly with lung, ovarian and breast cancer, but not directly caused by cancer or its metastasis. PCD is a condition whereby the Purkinje cells of the cerebellar cortex are damaged secondary to an autoimmune process. We report here on the case of PCD of subacute onset in a patient at 7 months after surgery for ovarian cancer. Although the cases of PCD has rarely been reported, the present case appears to be the first in Korea in which PCD was associated with anti-Yo antibody in patient with chemotherapy-responsive ovarian cancer. The clinical significance of PCD associated with anti-Yo antibody is reviewed.

False-negative results of conventional Papanicolaou cervical cytology in women with cervical conization / 부인종양

OBJECTIVE: The conventional Papanicolaou smear seems to be more accurate for detecting a high-grade squamous intraepithelial lesion (HSIL) than a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to investigate false-negative results of conventional Pap smear cytology in women with cervical conization. METHODS: This study was performed in Gynecologic Oncology Clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 1994 to December 31, 2004. 260 women from age 22 to 75 years had undergone conventional Papanicolaou cervical cytologic test and cervical conization. Conization was performed using ncold-knife cone' method or nlarge electrosurgical excision procedure (LEEP) cone' method. The cervical cytology were studied in comparison with histology of conization specimens. RESULTS: Of the 260 histologic diagnoses, there were 41 (15.8%) diagnoses of chronic cervicitis, 8 (3.1%) of CIN 1, 18 (6.9%) of CIN 2, 150 (57.7%) of CIN 3, 38 (14.6%) of SCC, 2 (0.8%) of AIS, 1 (0.4%) of ACC, and 2 (0.8%) of ASC. Pap cytology showed sensitivity of 97.9-98.2%, specificity of 4.9-6.7%, and false-negative rate of 1.8-2.2% according to the variables. CONCLUSION: Significantly false-negative rate of Pap cytology in women with conization was very low. And so, conventional Pap cytology is still clinically efficient for screening high-grade cervical lesions with adequate sampling technique.

Protein Expression Profile using Two-Dimensional Gel Analysis in Squamous Cervical Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Screening in cervical cancer is now progressing to discover candidate genes and proteins that may serve as biological markers and that play a role in tumor progression. We examined the protein expression patterns of the squamous cell carcinoma (SCC) tissues from Korean women with using two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometer. MATERIALS AND METHODS: Normal cervix and SCC tissues were solubilized and 2-DE was performed using pH 3~10 linear IPG strips of 17 cm length. The protein expression was evaluated using PDQuest 2-D software(TM). The differentially expressed protein spots were identified with a MALDI-TOF mass spectrometer, and the peptide mass spectra identifications were performed using the Mascot program and by searching the Swiss-prot or NCBInr databases. RESULTS: A total of 35 proteins were detected in SCC. 17 proteins were up-regulated and 18 proteins weredown-regulated. Among the proteins that were identified, 12 proteins (pigment epithelium derived factor, annexin A2 and A5, keratin 19 and 20, heat shock protein 27, smooth muscle protein 22 alpha, alpha-enolase, squamous cell carcinoma antigen 1 and 2, glutathione S-transferase and apolipoprotein a1) were protein previously known to be involved in tumor, and 21 proteins were newly identified in this study. CONCLUSION: 2-DE offers the total protein expression profiles of SCC tissues; further characterization of these differentially expressed proteins will give a chance to identify the badly needed tumor-specific diagnostic markers for SCC.

Diagnostic Efficacy of the Risk of Malignancy Index in Early Detection of Ovarian Cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the use of a risk of malignancy index (RMI) for early detection of ovarian cancer in patients with adnexal masses. METHODS: The preoperative RMI was obtained from 497 women who have visited our hospital between September 1994 and December 2004. The RMI is based on menopausal status, ultrasonographic findings, and serum CA-125 level. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each variable and the RMI were evaluated to distinguish between malignant and benign pelvic masses. RESULTS: The sensitivity and specificity of RMI was 42.85% and 88.57%. PPV and NPV was 40.74% and 92.11% for the total material. The RMI is more accurate statistically than the menopausal status, serum CA-125 levels separately in diagnosing malignancy, but the ultrasound features is more accurate than RMI in diagnosing malignancy. CONCLUSION: Our results suggests that RMI is not good as a primary screening tool for early detection of ovarian cancer because of its low sensitivity and low NPV than ultrasound. So further study is needed to support the diagnostic efficacy of RMI.

Correlation of Progesterone Challenge Test and Endometrial Thickness in Postmenopausal Women / 대한산부인과학회지

OBJECTIVE: The aim of this study is to assess the correlation of progesterone challenge test (PCT) and endometrial thickness as a primary screening test for endometrial pathology in postmenopausal women prior to hormonal replacement therapy (HRT). METHODS: 92 postmenopausal women were measured serum estradiol (E2) level, endometrial thickness by transvaginal ultrasonography, and followed by PCT before HRT. And we compared the results of PCT with endometrial thickness and E2 levels. RESULTS: Women with a positive result of PCT in 32% of case and 75.9% of positive test showed endometrial thickness 4 mm or more. However 60.3% of negative test showed endometrial thickness 4 mm or more. This resulted in a PPV=76%, NPV=40%, sensitivity=37%, and specificity=78%. Mean serum E2 was significantly higher in patient with positive PCT but serum E2 showed no positive correlation with endometrial thichness (CI 95%, P

A Case of Fetal Cardiac Tumor Diagnosed by Ultrasonography / 대한산부인과학회지

Primary tumors of the heart are uncommon in fetus and neonate, and most tumors are histologically benign. They remain clinically unimportant and regress with age, but they may cause mechanical obstruction and induce even life-threatening symptoms. Hemodynamic disturbance are correlated with the size and location of the tumors. Murmurs, arrhythmia, cyanosis, respiratory distress, and heart failure are main presenting signs of cardiac tumors in perinatal periods. The most common histological form of cardiac tumors in perinatal periods is rhabdomyoma. Rhabdomyomas are associated with tuberous sclerosis in 50% of cases. The widespread use of echocardiography and other new imaging techniques has contributed significantly to eariler diagnosis, treatment, and thus improving survival. We have experienced a case of fetal cardiac tumor which were detected by prenatal ultrasonographic evaluation in 21 weeks and 4 days of gestation. After termination, autopsy was performed and rhabdomyoma was diagnosed, but not accompanied tuberous sclerosis.

A Case of Cornual Pregnancy Complicated with Intraligamentary Pregnancy / 대한산부인과학회잡지

Cornual pregnancy, which is a rare form of ectopic pregnancy, is an implantation of embryo in the intramural portion of a fallopian tubes. The incidence of cornual pregnancy is reported to be between 2-4% of all tubal pregnancy, about 1% of ectopic pregnancy, and occurs once for every 2,500 to 5,000 live births. Because the greater distensibility and vascularlity of this site lead to rupture at a latter gestational age and rapid intraperitoneal hemorrhage, cornual pregnancy causes serious maternal mortality and morbidity. Intraligamentary pregnancy, also a form of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentary pregnancy is hardly ever made prior to laparotomy. The incidence of intraligamentary pregnancy is reported to be about once for every 245 all ectopic pregnancy, and about once for every 49,000 to 184,000 all pregnancy. We have experienced an extremely rare case of right cornual pregnancy complicated with right intraligamentary pregnancy which was proven by histopathologic diagnoses in a 34-year-old woman and report it with review of literatures.

Conventional Papanicolaou Cervical Cytologic Screening in Women for Health Check-up / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to obtain an important basic data about the clinical efficacy of the conventional Papanicolaou cervical cytology as a screening tool by estimating the prevalence rate of cervical cancer and precancerous lesion in the general population roughly according to The Bethesda System (TBS). METHODS: This study was performed in Health Check-up Center and Industrial Medicine clinic at Dankook University Medical Center from January 1, 1999 to December 31, 2001. Nine thousand and five hundred fourteen cases who had underwent conventional Papanicolaou cervical cytologic test were analyzed according to The Bethesda System (TBS). Abnormal cytologic diagnoses ((Atypical Squamous Cells of Undetermined Significance (ASCUS) or worse)) were compared with histologic diagnoses as a reference standard. RESULTS: Followings are the results summarized. 1. Of the 9,514 patients, 8 (0.08%) were diagnosed as unsatisfactory for evaluation. Of the 9,506 cases, there were 3,919 (41.23%) cytolologic diagnoses of Within Normal Limit (WNL), 5,368 (56.47%) of Benign Cellular Change (BCC), 131 (1.38%) of ASCUS, 41 (0.43%) of Low-grade Squamous Intraepithelial Lesion (LSIL), 33 (0.35%) of High-grade Squamous Intraepithelial Lesion (HISL), 7 (0.07%) of Squamous Cell Carcinoma (SCC), 7 (0.07%) of Atypical Glandular Cells of Undetermined Significance (AGUS). There was no cytologic diagnosis of Adenocarcinom (ACC). The ASCUS/SIL ratio was 1.77. 2. The age distribution of patients were as follows: 1 case under 19 years, 719 in the 20's, 2,963 in the 30's, 2,650 in the 40's, 2,020 in the 50's, 1,042 in the 60's, 110 in the 70's, 1 over 80 years. The mean age was 44.50 years. 3. Of 9,506 cases, there were 219 abnormal cytologic diagnoses (ASCUS/AGUS or worse). Of 219 cases, 40 (18.3%) showed high-grade cytologic diagnoses (HSIL, SCC, and ACC) if ASCUS and AGUS were excluded. There was no statistically significant relation between cytologic diagnoses and ages. 4. Of 219 cases with abnormal cytologic diagnoses, 38 patients had histologic diagnoses. Of the 9 ASCUS cases, 5 (55.55%) showed positive histologic LSIL or worse diagnoses. Of the 29 cytologic LSIL or worse cases, 22 (75.9%) showed positive histologic LSIL or worse diagnoses. Of the 21 cytologic HSIL or worse cases, 18 (85.7%) showed positive histologic HSIL or worse diagnoses. Of the 4 cytologic SCC cases, 4 (100%) showed high-grade histologic diagnoses (HSIL or SCC). Of 38 cases with histologic diagnoses, 23 (60.53%) showed high-grade histologic diagnoses ((HSIL, SCC, and Adenocarcinoma in situ (AIS)). There was a statistically significant relation between cytologic diagnoses and high-grade histologic diagnoses in squamous abnormalities. CONCLUSION: This study showed that 97.7% of cytologic diagnoses were negative and 60.5% of abnormal cytologic diagnoses (ASCUS or worse) were correlated with high-grade histologic diagnoses according to the criteria of TBS in general population. Our data also confirmed that conventional Papanicolaou cervical cytology is more accurate when a high-grade squamous intraepithelial lesion threshold is used. This study will play a relevant role in clinical practice of cervical cancer screening of general population.

Conventional Papanicolaou Cervical Cytologic Screening in Women for Health Check-up / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to obtain an important basic data about the clinical efficacy of the conventional Papanicolaou cervical cytology as a screening tool by estimating the prevalence rate of cervical cancer and precancerous lesion in the general population roughly according to The Bethesda System (TBS). METHODS: This study was performed in Health Check-up Center and Industrial Medicine clinic at Dankook University Medical Center from January 1, 1999 to December 31, 2001. Nine thousand and five hundred fourteen cases who had underwent conventional Papanicolaou cervical cytologic test were analyzed according to The Bethesda System (TBS). Abnormal cytologic diagnoses ((Atypical Squamous Cells of Undetermined Significance (ASCUS) or worse)) were compared with histologic diagnoses as a reference standard. RESULTS: Followings are the results summarized. 1. Of the 9,514 patients, 8 (0.08%) were diagnosed as unsatisfactory for evaluation. Of the 9,506 cases, there were 3,919 (41.23%) cytolologic diagnoses of Within Normal Limit (WNL), 5,368 (56.47%) of Benign Cellular Change (BCC), 131 (1.38%) of ASCUS, 41 (0.43%) of Low-grade Squamous Intraepithelial Lesion (LSIL), 33 (0.35%) of High-grade Squamous Intraepithelial Lesion (HISL), 7 (0.07%) of Squamous Cell Carcinoma (SCC), 7 (0.07%) of Atypical Glandular Cells of Undetermined Significance (AGUS). There was no cytologic diagnosis of Adenocarcinom (ACC). The ASCUS/SIL ratio was 1.77. 2. The age distribution of patients were as follows: 1 case under 19 years, 719 in the 20's, 2,963 in the 30's, 2,650 in the 40's, 2,020 in the 50's, 1,042 in the 60's, 110 in the 70's, 1 over 80 years. The mean age was 44.50 years. 3. Of 9,506 cases, there were 219 abnormal cytologic diagnoses (ASCUS/AGUS or worse). Of 219 cases, 40 (18.3%) showed high-grade cytologic diagnoses (HSIL, SCC, and ACC) if ASCUS and AGUS were excluded. There was no statistically significant relation between cytologic diagnoses and ages. 4. Of 219 cases with abnormal cytologic diagnoses, 38 patients had histologic diagnoses. Of the 9 ASCUS cases, 5 (55.55%) showed positive histologic LSIL or worse diagnoses. Of the 29 cytologic LSIL or worse cases, 22 (75.9%) showed positive histologic LSIL or worse diagnoses. Of the 21 cytologic HSIL or worse cases, 18 (85.7%) showed positive histologic HSIL or worse diagnoses. Of the 4 cytologic SCC cases, 4 (100%) showed high-grade histologic diagnoses (HSIL or SCC). Of 38 cases with histologic diagnoses, 23 (60.53%) showed high-grade histologic diagnoses ((HSIL, SCC, and Adenocarcinoma in situ (AIS)). There was a statistically significant relation between cytologic diagnoses and high-grade histologic diagnoses in squamous abnormalities. CONCLUSION: This study showed that 97.7% of cytologic diagnoses were negative and 60.5% of abnormal cytologic diagnoses (ASCUS or worse) were correlated with high-grade histologic diagnoses according to the criteria of TBS in general population. Our data also confirmed that conventional Papanicolaou cervical cytology is more accurate when a high-grade squamous intraepithelial lesion threshold is used. This study will play a relevant role in clinical practice of cervical cancer screening of general population.

Vaginal Bleeding Patterns on Continuous Combined Hormone Replacement Therapy using Micronized Progesterone in Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the patterns of vaginal bleeding on continuous combined hormone replacement therapy (HRT) with micronized progesterone (MP), compared with medroxyprogesterone acetate (MPA) and to find any effects of body weight, body mass index, age of menopause, and duration of postmenopausal amenorrhea on these patterns of vaginal bleedings. METHODS: In continuous combined HRT using MP, 0.625 mg conjugate equine estrogen (CEE) and 100 mg MP were daily administered orally in 100 postmenopausal women. In continuous combined HRT using MPA, 0.625 mg CEE and 2.5 mg MPA were daily administered orally in 70 postmenopausal women. And we observed the vaginal bleeding patterns for six months after initiation of therapy. RESULTS: No vaginal bleeding or only slight vaginal spotting within 3 months were in 92 women (92%) in continuous combined HRT using MP. Only 8 women (8%) showed continuous bleeding for more than three months or heavy bleeding, so they stopped HRT or changed to other regimens. These were statistically significant lower rates of frequency of vaginal bleeding (35%) and drop out (8%), compared with the group using MPA (62.9%, and 42.9%) in our previous study. There were no statistically significant differences in the means of body weight, body mass index, and age of menopause between two treatment groups, but the mean of durations of postmanopausal amenorrhea was significantly longer in MP treatment group than that of MPA treatment group. In each treatment group, there were no statistically significant differences in the means of body weight, body mass index, duration of postmanopausal amenorrhea, and age of menopause according to the frequency of vaginal bleeding. CONCLUSION: Continuous combined HRT using MP showed less bleeding and better compliance than that using MPA.

PapSure Test for Cervical Cancer Detection / 대한산부인과학회잡지

OBJECTIVE: The PapSure test, a combination of Papanicolaou smear cytology and speculoscopy, is a direct visual cervical cancer screening method. Speculoscopy, or magnified chemiluminescent examination (MCE), is a new visual method for the detection of cervical neoplasia. It utilizes low magnification and a special "blue-white" chemiluminescent light. The purpose of this study was to evaluate the effectiveness of PapSure test for cervical cancer detection, as compared with the Pap cytology alone. METHODS: This prospective, randomized, university hospital-based clinical study was performed in the outpatient clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from July 1, 2002 to November 30, 2003. Of the 508 patients aged 17-81 years who had undergone conventional Papanicolaou cervical cytologic test, speculoscopy, and colposcopy, 254 cases underwent histopatologic diagnoses. RESULTS: Of the 508 patients, there were 131 (25.8%) PapSure diagnoses of positive, 377 (74.2%) of negative. Of the 254 histologic diagnoses, there were 166 (65.4%) diagnoses of benign, 37 (14.6%) of LSIL, 30 (11.8%) of HSIL, and 21 (8.3%) of carcinoma. Pap smear showed sensitivity of 79.5%, and specificity of 91.6%, whereas PapSure test showed sensitivity of 89.8%, and specificity of 77.1%. The addition of speculoscopy to the routine Pap smear resulted in finding 2 of the 30 (7%) women with HSIL which was not statistically significant, and 7 of the 28 (25%) women with LSIL which showed statistically borderline significance. CONCLUSION: PapSure test showed a higher sensitivity rate and a lower false negative rate than Pap smear only as a screening test. Pap smear cytology and speculoscopy seem to be additive, and so the PapSure test is thought to be a very effective method for detecting cervical neoplasia.

Two Cases of Blue Nevus in the Endocervix of the Uterus / 대한산부인과학회잡지

Blue nevus of the endocervix is an uncommon lesion. Blue nevus commonly occurs on the skin of hands and feet, occasionally it has been observed in the mucosa of the oral cavity, and rarely observed in the uterine cervix, vagina, prostate, lymph nodes, and even breast. Most of them have been discovered incidentally. Our two cases (in 41 years and 45 years) were also incidentally found in the endocervix of the uterus, which were obtained by total abdominal hysterectomy under the diagnosis of leiomyoma. The expressions of S-100 protein in the blue nevus were noted. We report them with review of literatures.

Relationship between the Maternal-Fetal Complications and the Severity of HELLP Syndrome, Classified based on Maternal Platelet Count Nadir / 대한산부인과학회잡지

OBJECTIVE: To determine the incidence of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and assess the relationship between the maternal-fetal complications and the severity of HELLP syndrome, classified based on platelet count nadir. METHODS: We reviewed the maternal and neonatal charts of ten pregnancies complicated by HELLP syndrome, managed at Dankook University Hospital between January, 1995 and December, 2002. Women were divided into 2 groups as class I HELLP which had a maternal platelet nadir 50,000 and 100,000/mm3. We compared the maternal and fetal complications between class I and class II HELLP syndrome. But we did not analyze statistically due to small number of patients. RESULTS: There were four cases of class I HELLP and six cases of class II HELLP syndrome. The incidence of HELLP syndrome was 0.10% (10/10,238) in total deliveries and was 2.26% (10/443) in women with severe pre-eclampsia or eclampsia. The mean level of platelet counts nadir was 41,500/mm3 in class I and 64,000/mm3 in class II HELLP. The mean platelet recovery days (more than 100,000/mm3) were 6.0 and 4.2 days in each class. The mean values of the maximal aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT) and uric acid might show no differences, but there might be difference in lactate dehydrogenase (LDH) levels which were 5854 and 1388 IU/L in each class. All patients with class I HELLP syndrome showed maternal complications, but only one patient with class II HELLP showed maternal complications. There might be no differences in the mean gestational ages and birth weights. The neonatal complications were similar in each class. CONCLUSION: Our data suggest that patients with class I HELLP syndrome may be at increased risk for serious maternal complications, but the neonatal complications may be associated with gestational ages.