Clinical Significance of HPV DNA test for Management of Patients with Diagnosis of Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesions / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the clinical efficacy of high risk HPV DNA test using PCR for the detection of high-grade CIN or invasive cancer from patients with ASCUS or LSIL on Papanicolaou smear. METHODS: Sixty one patients with a Papanicolaou smear report of atypical squamous cells of undetermined significance or a low-grade squamous intraepithelial lesion underwent Cervical colposcopy and directed cervical biopsy and human papillomavirus test by PCR. We compared the detection rate of the high grade CIN and invasive cancer by Papanicolaou smear method only with that of both Papanicolaou smear and HPV PCR method. and we decided to be significant when P value was below 0.05 by SAS (v 6.02) program. RESULTS: The detection rate of high risk HPV DNA was 50.8% (31/61). The detection rate of high risk HPV DNA in high grade CIN and invasive cancer was 84.2% (16/19). Higher the grade of biopsy, more the detection rate of high risk HPV DNA. False negative rate which appeared high grade CIN or invasive cancer by biopsy was 31.2% (19/61) in Papanicolaou smear method only and 4.9% (3/61) in both Papanicolaou smear and HPV DNA method. CONCLUSION: We thought that additional HPV DNA test was useful to dectect behind high grade CIN or invasive cancer when the Papanicolaou smear result was ASCUS or LSIL.

A case of heterotopic pregnancy following in vitro fertilization and embryo transfer / 대한산부인과학회잡지

A heterotopic (combined) pregnancy, ectopic pregnancy accompanied by coexisting uterine pregnancy, is a rare phenomenon in general population. Recently, its incidence has increased significantly due to increased use of assisted reproductive technologies. But diagnosis of heterotopic pregnancy is often delayed or missed because heterotopic pregnancy is still rare and difficult to diagnose. We have a patient who had simultaneous intrauterine pregnancy and left tubal pregnancy after in vitro fertilization and embryo transfer. We performed left salpingectomy and she delivered 3.13 kg healthy female baby 32 weeks later. So we report this case with a brief review of the literatures.

A case of endometrial cancer in a young patient with polycystic ovary syndrome / 대한산부인과학회잡지

Endometrial cancer is a rare condition in women under 40 years of age. However, patients with anovulatory polycystic ovary syndrome are at risk of developing endometrial cancer due to unopposed and prolonged effect of estrogen on the endometrium. Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age resulting from insulin resistance and the compensatory hyperinsulinemia. This has adverse effects on multiple organ systems and may result in alteration in serum lipids, anovulation, abnormal uterine bleeding and infertility. In addition, PCOS may place the patients at risk for the development of type 2 diabetes, hypertension, endometrial cancer and cardiovascular disease. We report a case of endometrial cancer in a young patient with PCOS with brief review of the literatures.

Two Cases Reports of Prevention of Hypoglycemia with Administration of Insulin lispro on Diabetes in Pregnancy / 대한산부인과학회잡지

Insulin therapy is indicated in the treatment of gestational diabetic women and overt diabetic pregnant women for hyperglycemia after failure to respond to the diets and exercise regimens. The insulin is administered to mimic normal pancreatic function. The normal pancreas secretes 50% of the total daily insulin as mealtime boluses. This delivery may be mimicked by four-injection-per-day of combination of NPH and regular insulin (RI). Hypoglycemia is a well-recognized complication of intensive insulin therapy in patients with Type II diabetes. Recently, it has been reported that insulin-lispro, an analogue of regular human insulin with a peak insulin action achieved with a 1 hour after injection improves postprandial glucose concentration in non-pregnant diabetic patients. Treatment of gestational or diabetic pregnant women with NPH and insulin-lispro has significantly lower postprandial glucose levels without an increase in hypoglycemic events. Here, we report 2 cases of hyperglycemic control with four times daily administration of NPH & insulin-lispro on diabetes in pregnancy, with brief reviews.

The Maternal and Fetal Adrenal Effect of 1 cycle Dexamethasone on women with Preterm Labor / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to determine whether 1 cycle of dexamethasone administration to women at risk of preterm delivery causes adrenal suppression METHODS: Nonpregnant ten control subjects were checked baseline cortisol and stimulated cortisol level after low-dose (1 microgram) ACTH stimulation test. Ten women at risk of preterm delivery had two weekly low-dose (1 microgram) ACTH stimulation tests with the first one at admission. Immediately after the first ACTH stimulation test, we gave each women a 5 mg dexamethasone dose intramuscularly and repeated it 12 hours later for two days. Serum cortisol levels were measured before (baseline) and 30 minutes after ACTH administration. RESULTS: All ten subjects had normal baseline and stimulated cortisol levels for the first ACTH stimulation test. The adrenal suppressed Group was composed of 5 patients. But the remainders was not suppressed. Mean baseline serum cortisol levels decreased from 38.52 microgram/dL (before dexamethasone) to 33.26 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. The mean stimulated cortisol levels also decreased from 46.40 microgram/dL (before dexamethasone) to 45.02 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. CONCLUSIONS: Antenatal administration of 1 cycle dexamethasone produced slightly adrenal suppression, but no adrenal insufficiency, in some women at risk of preterm delivery and may be harmless to maternal and fetal adrenal function.

Prolapse of the Fallopian Tube into the Vaginal Vault after Abdominal Hysterectomy / 대한산부인과학회잡지

Prolapse of the fallopian tube into the vaginal vault after hysterectomy is a rare phenomenon and it occurs more frequently after vaginal hysterectomy than abdominal hysterectomy. The exact incidence of tubal prolapse is unknown, because most of cases remain undiagnosed and may resolve before detection. The tubal prolapse may be suspected when granulation tissue or tender friable tissue are detected in vaginal cuff in women complaining lower abdominal pain, dysparenunia, vaginal discharge, or postcoital spotting. The definitive diagnosis of fallopian tube prolapse is made only by histologic confirmation. Reported methods of treatment have included transvaginal excision or transabdominal excision, cautery, and combined vaginal and laparoscopic salpingectomy. We experienced a case of fallopian tube prolapse after abdominal hysterectomy in a 40-year-old woman. We present this case with a brief review of the literature.

Clinical analysis of Pelviscopic surgery / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the safety and efficacy of pelviscopic surgery. METHODS: Between May 1996 and April 2000, we evaluated indication of operation, mean age, parity, previous operation history, type of operation, duration of hospitalization and complications. RESULTS: The results are summarized as follows ; 1) The mean age of patients was 34.8 years with ranges between 20 and 55 years old. 2) The majority of patients were between 36 years and 40 years old(23.6%). 3) The major clinical indications included 174 cases of adnexal mass(33.4%), 125 cases of ectopic pregnancy(24.0%), 59 cases of endometriosis(11.3%). 4) The types of operation composed of 168 cases diagnostic laparoscopy(30.7%), salpingectomy(17.2%), cystectomy(11.4%), LAVH(11.2%). 5) Previous laparotomy history was found in 146 cases(28.0%). 6) The mean duration of hospitalization was 4.4 days. CONCLUSIONS: The pelviscopy can be safely performed, resulting in reduced surgical morbidity, less blood loss, less postoperative discomfort and pain, shortened hospital stays and shorter recovery days. With the increased use of markers and ultrasonography to decrease the possibility of inappropriate surgery, combined with more defined exterpation techniques, the interest in laparoscopic ovarian surgery is burgeoning. And technologic advances afford us the opportunity to offer patients a number of alternatives to open surgery. The choice of anesthetic technique varies with requirements of the surgeon, the health status and preference of the patient, the type of facility and the availability of well trained professionals, support personnel and equipment. In conclusion, the pelviscopic surgery is alternative to laparotomy.

Three dimensional ultrasound volumetry of amniotic fluid in pregnant women / 대한산부인과학회잡지

OBJECTIVES: Our study was to measure how well semiquantitative three-dimensional ultrasonographic measures of amniotic fluid in the third trimester, to investigate the relationship between three-dimensional amniotic fluid volume and amniotic fluid index, two dimensional amniotic fluid volumes. METHODS: We compared amniotic fluid volume as measured by three-dimensional ultrasonographic techniques with amniotic fluid index including two dimensional amniotic fluid volume in 33 women during in the third trimester. RESULTS: There was highly significant linear correlations of three-dimensional amniotic fluid volumes with AFI (r=0.6898) and two dimensional amniotic fluid volume (r=0.7926). CONCLUSION: Three-dimensional ultrasonographic technology has clinical significance as a tool to measure amniotic fluid volume. There are highly significant correlations of three dimensional amniotic volumes with AFI and two dimensional volume.

Three dimensional ultrasound volumetry of amniotic fluid in pregnant women / 대한산부인과학회잡지

OBJECTIVES: Our study was to measure how well semiquantitative three-dimensional ultrasonographic measures of amniotic fluid in the third trimester, to investigate the relationship between three-dimensional amniotic fluid volume and amniotic fluid index, two dimensional amniotic fluid volumes. METHODS: We compared amniotic fluid volume as measured by three-dimensional ultrasonographic techniques with amniotic fluid index including two dimensional amniotic fluid volume in 33 women during in the third trimester. RESULTS: There was highly significant linear correlations of three-dimensional amniotic fluid volumes with AFI (r=0.6898) and two dimensional amniotic fluid volume (r=0.7926). CONCLUSION: Three-dimensional ultrasonographic technology has clinical significance as a tool to measure amniotic fluid volume. There are highly significant correlations of three dimensional amniotic volumes with AFI and two dimensional volume.

Two Cases of Amnioinfusion for the Midtrimester Oligohydroamnios / 대한산부인과학회잡지

Reduced amniotic fluid volume generally leads to a poor perinatal outcome, especially when it is observed in the second trimester. The recent obstetric literatures have been reporting on various applications of amnioinfusion in the diagnostic, prophylactic and therapeutic management of oligohydroamnios. We experienced two cases of amnioinfusion, which were used to diagnose or to manage the midtrimester oligohydroamnios and we report them with a brief review.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

The significance of the TDx-FLM assay in the fetal lung maturity / 대한산부인과학회잡지

OBJECTIVE: The TDX analyzer, an automated fluorescence polarimeter, has been utilized to assess surfactant content in amniotic fluid. Amniostat-FLM is an immunologic semiquantitative agglutination test for determining the presence of phosphatidylglycerol in human amniotic fluid at concentration indicative of fetal lung maturity. We evaluated the usefulness of the recently introduced TDx-FLM assay in determining fetal lung maturity. METHODS: Seventy-three samples of amniotic fluid were analyzed. Among them, 18 samples were compared with Amniostat-FLM assay. RESULTS: Surfactant/albumin ratio using TDx-FLM assay increased with longer gestational age. And the concordance rate between Amniostat-FLM assay and TDx-FLM assay was 66.9%. CONCLUSION: The TDx-FLM assay appears to be a useful test in the field of fetal lung maturity testing.

Difference between Arterial and End-tidal CO2 Tension and its Relationship with the Minute Volumes Per Body Weight during General Anesthesia / 대한마취과학회지

The purpose of this study is to evaluate the relationship between arterial and end-tidal CO2 tension during general anesthesia. Sixty one patients age 21~40 years old without history of cardiopulmonary disease in American Society of Anesthesiologists physical status 1, were studied. Thoracic or upper abdominal operations were excluded in this study. Anesthesia was maintained by halothane, nitrous oxide and oxygen. Respirations were controlled in all patients with a Dameca ventilator and minute volumes were adjusted to provide FECO2 levels considered appropriate by anesthetist. The concentration of end-tidal carbon dioxide was continuously monitored with ENGS TROM ELIZA DUO CO2 and O2 analyzer. The radial artery was punctured 30 minutes after the surgical incision and 7oth arterial and endtidal carbon dioxide tension were measured simultaneously. The results were as follows : 1) The mean arterial to end-tidal CO2. tension difference was 2.5+/-3.9 torr. 2) There was a constant correlation between arterial and end-tidal CO2 tension regardless of the degree or minute volume. 3) There was no significant correlation 7etween smokers and non-smokers in male patients.