Leukocytes and lactobacilli of vaginal discharge as a predictor of pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate whether the vaginal polymorphonuclear leukocytes and few lactobacilli on microscopic evaluation of a saline wet preparations would be associated with pelvic inflammatory disease (PID) in Korean women. MATERIALS AND METHODS: We performed a cross-sectional study of 556 women between 16 and 78yrs of age from May 2001 to May 2003. Wet-mount microscopic examination of vaginal discharge was done on all patients. Positive vaginal polymorphonuclear leukocytes was defined as more than 10 white blood cells per high-power field on microscopic examination, and few lactobacilli was defined as less than 30 per high-power field on microscopic examination. The diagnosis of PID was relied on the minimal criteria delineated by the Centers for Disease Contral and Prevention, elevated CRP or ESR and positive anaerobic cultures. RESULTS: On univariate analysis, positive vaginal polymorphonuclear leukocytes and few lactobacilli were associated with PID, but age (less than 25) and marital status were not. On multivariate analysis using multiple logistic regression, odds ratios of positive vaginal polymorphonuclear leukocytes and few lactobacilli for PID were 5.995 (95%CI: 3.056-11.761) and 24.39 (95%CI: 10.989-55.556) respectively. The sensitivity and negative predictive value of positive vaginal polymorphonuclear leukocytes or few bacilli for predicting PID were 90.6% and 94.42% respectively. CONCLUSION: Positive vaginal polymorphonuclear leukocytes and few lactobacilli were strongly associated with PID. Positive vaginal polymorphonuclear leukocytes and few lactobacilli have a high sensitivity and negative predictive value for predicting PID. Therefore the existence of vaginal polymorphonuclear leukocytes and few lactobacilli are thought hereafter to be useful marker to diagnose PID.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

Clinical characteristics and pregnancy outcomes of hyperemesis gravidarum / 대한산부인과학회지

OBJECTIVE: It is controversial that hyperemesis gravidarum has adverse effect on pregnancy. The purpose of this study is to evaluate clinical characteristics and pregnancy outcomes in women with hyperemesis gravidarum. METHODS: We identified 52 women who was treated as inpatients for hyperemesis gravidarum and had delivered babies between Jan. 2001 and Oct. 2004. The control group was 123 women who had not suffered from hyperemesis gravidarum. We performed a retrospective analysis of obstetric and pediatric medical records. We analyzed the data using student's t-test and Chi-square test and p-value<0.05 was considered as statistically significant. RESULTS: The average height (162.5+/-0.6 vs. 160.6+/-0.4 cm, Mean+/-SE) was significantly higher in hyperemesis group. The average pre-pregnancy BMI (20.2+/-0.3 vs. 21.0+/-0.2 kg/m2) and maternal age (29.8+/-0.5 vs. 31.2+/-0.3 years) were significantly lower in hyperemesis group. The average weight loss was 2.6 kg and the average hospital stay was 5.4 days. The average concentration of serum electrolytes were within normal limits. The hematocrit (35.4+/-0.4 vs. 34.3+/-0.2%) and unconjugated estriol (1.336+/-0.055 vs. 1.126+/-0.034 MoM) were significantly higher in hyperemesis group. Vaginal bleeding during the first trimester was more common in hyperemesis group (16.4 vs. 4.7%). Pregnancy outcomes between hyperemesis and control group were similar in average gestational age, average birth weight, average Apgar scores, sex ratio, congenital malformation and neonatal morbidity. CONCLUSION: Pregnant women with hyperemesis had significant differences in some demographic characteristics, hematocrit, unconjugated estriol and vaginal bleeding during the first trimester, but had similar pregnancy outcomes.

A Comparison of Different Pelvic Reconstruction Surgeries Using Mesh for Pelvic Organ Prolapse Patients

This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.

The Significance of Bladder Trabeculation in the Female Lower Urinary System: An Objective Evaluation by Urodynamic Studies

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.

The Relationship between Maximal Urethral Closure Pressure and Functional Urethral Length in Anterior Vaginal Wall Prolapse Patients According to Stage and Age

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

Hysteroscopic diagnosis and management of uterine submucosal myoma with cystic degeneration featuring missed abortion by transvaginal ultrasound / 대한산부인과학회지

Imaging studies, notably ultrasound or MRI may aid in clinical evaluation. However, in some circumstances such imaging studies can be misleading. Here we are reporting with a brief review, an experienced case where uterine submucosal myoma with cystic degeneration is successfully diagnosed and treated with hysteroscopy.

Comparison of Perioperative Complications between Reconstructive Pelvic Surgery and General Gynecologic Surgery

The purpose of this study was to compare the perioperative complication rates of reconstructive pelvic surgery and general gynecologic surgery, and to identify the predictive risk factors for perioperative complications in reconstructive pelvic surgery. The medical records of 148 reconstructive pelvic surgery patients and 146 general gynecologic surgery patients were reviewed, and the types of complications, along with their rates and predictive risk factors were examined. The statistical analysis included descriptive statistics and logistic regression. There was no difference in the type of complications between reconstructive pelvic surgery and general gynecologic surgery. The prevalences of perioperative complications were 34.4% in the reconstructive pelvic surgery group and 26.7% in the general gynecologic surgery group. Intraoperative blood loss (p= 0.006) and the duration of surgery (p=0.014) were independent risk factors for perioperative complications in the reconstructive pelvic surgery group. The perioperative complication rates for the patients undergoing reconstructive pelvic surgery were not higher than those of the patients undergoing general gynecologic surgery, even though more procedures were performed and a longer duration of surgery was needed in the former cases. Since the duration of surgery and the amount of blood loss are the major factors affecting the complication rate, decreasing these two factors would be the key to improving the outcomes of patients undergoing reconstructive pelvic surgery

Hidden Y Chromosome and Marker Chromosome Identification by FISH (Fluorescence in Situ Hybridization) in Turner Syndrome / 대한산부인과학회잡지

OBJECTIVE: To assess the effectiveness of hidden Y chromosome and marker chromosome identification by FISH (Fluorescence in Situ Hybridization) in Turner syndrome. METHODS: Data was collected retrospectively from 25 patients with or without marker chromosome confirmed Turner syndrome by chromosomal study in Department of Obstetrics and Gynecology, Yonsei University Medical Center. FISH was performed on all patients for hidden Y chromosome and marker chromosome identification. RESULTS: FISH showed the origin of marker chromosome in 9 patients whose karyotypes were 45,X/ 46,X+mar, 5 patients were positive for SRY gene. Of 16 patients whose karyotypes were 45,X or 45,X/46,XX, there was no hidden Y chromosome indentification by FISH. CONCLUSION: FISH for marker chromosome identification in Turner syndrome is a rapid and effective procedure. But to enable widespread use of hidden Y chromosome identification by FISH in Turner syndrome, further studies involving many cases are warranted.

A Successful Surrogate Gestational Pregnancy after IVF-ET in a Patient with Mayer-Rokitansky-Kuster-Hauser Syndrome / 대한산부인과학회잡지

The first pregnancy following in-vitro fertilization (IVF) and the subsequent transfer to the surrogate was reported in 1985. Afterward, IVF-surrogacy became a viable reproductive alternative for couples who would otherwise be unable to produce a genetic child. We have experienced a case of successful surrogate pregnancy in patient with congenital absence of vagina (Mayer-Rokitansky-Kuster-Hauser Syndrome). After oocyte retrieval through the neovagina, the embryo transfer was performed to a surrogate gestational mother. Two male babies (2,790 gm, 2020 gm) were delivered at 36+3 weeks of gestation.

The Role of Estrogen Receptor, Progesterone Receptor and p53 in Development of Stress Urinary Incontinence

Recent studies have been reported the roles of the estrogen receptor (ER), progesterone receptor (PR) and p53 in the development of a pelvic organ prolapse (POP). The pathogenesis of stress urinary incontinence (SUI) is related to that of POP in the weakness of pelvic support. Therefore, this study was carried out to assess the relationship between ER, PR, p53 and the development of SUI, and to elucidate the biomolecular pathophysiology of SUI. The periurethral fascia was obtained from 6 menopausal patients diagnosed with SUI and 10 menopausal patients without SUI who visited the Department of Obstetrics and Gynecology, Severance Hospital, Seoul, Korea. The relative ER, PR and p53 protein levels in the periurethral fascia were obtained by western blot analysis and densitometry. A Mann-Whitney U test was used for statistical analysis (p< 0.05). The mean age (+/-SD) of the 16 patients was 59.0 +/-5.5 years (range, 50-74 years). The mean body mass index was 25.2 +/-2.7 kg/m2 (21.8 - 30.8) and the average number of vaginal deliveries was 2.8 +/-1.9 (1.0 - 9.0). The ER level (0.33 +/-0.17 vs. 1.86 +/-0.83, p= 0.02) and the p53 level (1.25 +/-0.67 vs. 4.71 +/-2.40, p= 0.01) were lower in the experimental group. However, the PR level of the two groups were similar (0.64 +/-0.13 vs. 0.48 +/-0.33, p=0.56). The p53 and ER levels were significant lower in the study group. This suggests that p53 and ER might be important factors in the development of SUI. Further prospective studies about the association of ER, p53 and SUI will be needed to elucidate the molecular pathogenesis of SUI.

The Predictive Values of Various Parameters in the Diagnosis of Stress Urinary Incontinence

The Maximum Urethral Closure Pressure (MUCP) and Functional Urethral Length (FUL) are significant parameters of the Urethral Pressure Profile (UPP), while the Q-tip angle and Bladder Neck Descent (BND) are the significant parameters of urethral hypermobility. We performed a study to evaluate the effects and predictive values of each of these parameters in the diagnosis of Stress Urinary Incontinence (SUI). A retrospective study was done involving 90 SUI patients and 38 non-SUI patients who underwent urodynamic study, Q-tip test and perineal ultrasound at Yonsei Medical Center between January, 1999 and February, 2002. There was no statistical difference between the SUI and non-SUI groups in terms of mean age, delivery history, menopausal age and body mass index. While the FUL and Q-tip angle showed significant differences (33.18 +/- 19.55 vs 33.12 +/- 13.37 mm, p=0.002; 65.94 +/- 21.69 vs 56.45 +/- 26.53 degrees, p=0.02, respectively) neither the MUCP nor the BND showed any significant difference between the two groups (60.06 +/- 29.92 vs 48.97 +/- 42.95 cmH2O, p > 0.05; 1.09 +/- 0.75 vs 0.85 +/- 0.76 cm, p > 0.05; 0.71 +/- 0.80 vs 0.53 +/- 0.72 cm, p > 0.05). The odds ratios for the FUL and Q-tip angle were 1.038 (1.014, 1.061) and 1.017 (1.001, 1.033), respectively. The FUL and Q-tip angle had cut-off values of 1.36 cm (sensitivity: 68.8%, specificity : 54.1%, PPV : 73.8%, NPV : 48.1%) and 20.47 degrees (sensitivity : 93.3%, specificity : 18.17%, PPV : 68.2%, NPV : 60%), respectively, in the diagnosis of SUI. The area under the curve (AUC) of the FUL and Q-tip angle were on average 0.625 (p=0.0016) and 0.575 (p=0.0012), respectively. Both the FUL and Q-tip angle showed a significant difference between SUI patients and the normal group. However, their value as a diagnostic tool was trivial, and since their sensitivity, specificity, positive predictive value and negative predictive value showed inconsistent results at each cut-off value, it would be difficult to apply them to clinical use. A further study is required to set-up standard diagnostic values of these variables for clinical use.

Steroid Hormone Metabolism in Patients with Pelvic Organ Prolapse / 대한산부인과학회잡지

OBJECTIVE: To identify 1) whether the endogenous steroid hormone metabolism in patients with pelvic organ prolapse was different from that of normal women, 2) the relationship between endogenous steroid hormone metabolites and the stage of the pelvic organ prolapse. METHODS: Twenty postmenopausal women who were clinically diagnosed as having pelvic organ prolapse and 20 volunteer postmenopausal women not having pelvic organ prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of the endogenous steroids and the degree of pelvic organ prolapse. Urinary profiles of the endogenous steroids were assayed by gas chromatography-mass spectrometry. RESULTS: The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the Body Mass Index (BMI) was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and in normal subjects, respectively. The number of patients in each stage were 4 in stage I, 4 in stage II, 6 in stage III and 6 in stage IV. 5-androstene-3beta, 16beta, 17beta-triol (5-AT), 11beta-hydroxy androstenedione (An) and 17beta-estradiol were significantly increased in patients with pelvic organ prolapse over that of the control group (0.76 +/- 0.67 vs 0.06 +/- 0.03 micro mole/g creatinine; p=0.002, 1.16 +/- 0.83 vs 0.65 +/- 0.23 micro mole/g creatinine; p=0.04, 15.08 +/- 9.81 vs 8.53 +/- 6.19 micro mole/g creatinine; p=0.04). However, tetrahydrocortisone (THE) was significantly increased in the control group over that in patients having pelvic organ prolapse (9.80 +/- 6.21 vs 5.22 +/- 4.89 micro mole/g creatinine; p=0.04). The androgen metabolites, 5-AT and THE significantly correlated with the POP-Q stage (R=0.418; p=0.027, R=0.46; p=0.016). Among the estrogen metabolites, 17beta-estradiol was correlated to the POP-Q stage but not mathematically significantly (R=0.38; p=0.05) and the 17beta-estradiol/estrone ratio weakly correlated to pelvic organ prolapse stage (R=0.14; p=0.49), by showing a low correlation coefficiency. CONCLUSION: The urinary concentrations of 17beta-estradiol, 5-AT and 11beta-hydroxy An increased in patients with pelvic organ prolapse over that of the control group and 5-AT, THE and 17beta-estradiol showed a relationship to the progression of pelvic organ prolapse in Korean women. The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of pelvic organ prolapse.

Investigation of Colposcopy Information on the Internet

The Internet is a massively expanding body of information which includes medical resources. It is easier than in the past for anyone with some knowledge and effort to access the Internet. Medical professionals as well as patients have a similar ability to research a medical topic through the Internet. As medical professionals, we are concerned whether the medical information found on the Internet by patients is current and accurate. There are relatively few reports that critically examine where patients and family members acquire medical information. To assess the accuracy and completeness of information regarding colposcopy on the Internet, we categorized and defined the information on the Internet through systematic study. We chose eight search engines available on the homepage of Explorer to search and analyze the information obtained from a search for the topic of colposcopy. In addition, we analyzed whether the colposcopy information contained peer-review or reference in order to evaluate its reliability. The numbers of uniform/universe resource locators (URLs) varied considerably, ranging from 11 to 23300, when we tested the search engines using different combinations of capitalization and spellings. Descriptions of information from 181 sites located by a search engine (Yahoo) were also evaluated into five types, ranging from diagnostic to anecdotal information. In terms of the peer-review system, inaccurate or misleading information was found on web pages which might lead patients to doubt and distrust their medical specialists whose information was contradictory to that which they had obtained themselves. We recognize that the Internet has a positive and potential power in partnership with medical professionals to educate patients, helping them to overcome their disease. Nevertheless, we suggest the need to take an active role in identifying the Web sites containing accurate medical information and evaluating their quality.

Hysteroscopic Endometrial Ablation as a Treatment of Abnormal Uterine Bleeding in Renal Transplant Patients / 대한산부인과학회잡지

OBJECTIVE: To assess the effectiveness and safety of hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients. METHODS: Data were collected retrospectively from 62 patients referred to Department of Obstetrics and Gynecology, Yonsei University Medical Center from January 1999 to December 2001 for abnormal uterine bleeding with prior history of renal transplantation who subsequently received hysteroscopic endometrial ablation. Hormonal status of these patients were evaluated before the operation by sampling estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), and prolactin. Mean follow-up duration was 6 months. Levonorgestrel-releasing intrauterine system (LNG-IUS)s were inserted in those who experienced recurrent bleeding. RESULTS: Mean age of patients was 34.6+/-6.7 years and mean duration from renal transplant to onset of abnormal uterine bleeding was 4.5+/-2.5 years. All hormone levels (E2, LH, FSH, TSH, prolactin) were within normal range. 54 out of 62 patients (87.0%) who underwent hysteroscopic endometrial ablation reported decreased bleeding: amenorrhea in 25 (40.3%), spotting in 19 (30.6%), and eumenorrhea in 10 (16.1%). None reported complications related to the procedure. LNG-IUSs were inserted into 8 patients who experienced continuous bleeding, 5 out of whom showed symptomatic improvement: spotting in 3 (4.9%) and eumenorrhea in 2 (3.2%). 3 patients in whom LNG-IUS had no effect received total abdominal hysterectomy. CONCLUSION: Hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients is an effective and safe procedure.

Rapid Prenatal Diagnosis of Trisomy 21 by Real-Time Quantitative Polymerase Chain Reaction / 대한산부인과학회잡지

OBJECTIVE: Trisomy 21 (Down syndrome) is the most common chromosomal anomaly which occurs 1 out of 700-1000 birth. Current techniques such as amniocentesis, chorionic villi sampling (CVS), require lengthy laboratory culture procedures and high costs. This study was undertaken to establish a rapid prenatal diagnosis of trisomy 21 using real-time quantitative polymerase chain reaction of fetal DNA from amniotic fluid. METHODS: Real-time quantitative PCR was performed with DNA template obtained from 14 normal serum, 10 normal amniotic fluid samples, 14 Down syndrome serum, and 7 Down syndrome amniotic fluid samples. Primers for D21S167 and S100B of chromosome 21 were used. Primers that direct amplification of 165-bp fragment of the IGFI (Insulin-like growth factor-1) gene on chromosome 12 are included to generate an internal standard for quantitation. RESULTS: The relative levels of D21S167 and S100B were 2.6 and 2.4 times higher in the serum of Down syndrome patients compared to the control group. The difference between these two groups was statistically significant (P-value: 0.0012 and 0.0016). The relative levels of D21S167 and S100B were 2.1 and 2.7 times higher in the amniotic fluid of Down syndrome fetuses compared to control group. The difference between these two groups was statistically significant (P-value 0.0379 respectively). CONCLUSION: Prenatal diagnosis of trisomy 21 by real-time quantitative PCR-associated STR (small tandem repeats) analysis of D21S167 and S100B is useful, accurate and rapid diagnostic method and also can be employed in diagnosis of trisomy 13, 18. Furthermore, it may also be useful for prenatal diagnosis with fetal DNA from maternal blood and for preimplantation genetic diagnosis.

Treatment Outcomes of Uterine Artery Embolization and Laparoscopic Uterine Artery Ligation for Uterine Myoma

In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.

Laparoscopic Management of Early Primary Abdominal Pregnancy / 대한산부인과학회잡지

Abdominal pregnancy is a very rare case consisting 1% of ectopic pregnancy and occurring once in 372-9714 of normal pregnancies. However, the possibility of massive bleeding which is a main cause of maternal death can lead to the death rate of 5.1 in every 1000 cases and is certainly a difficult subject in proceeding laparoscopic procedures. Here we are reporting with a brief review, an experienced case where an abdominal pregnancy is successfully treated with laparoscopy without massive bleeding or any other complications.

Correlation of post-operative morbidity and various time intervals between large loop excision of transformation zone and total abdominal hysterectomy / 대한산부인과학회잡지

OBJECTIVE: This study was aimed to detail the effects of various time intervals between large loop excision of transformation zone (LLETZ) and total abdominal hysterectomy (TAH) upon post-operative morbidity. METHODS: The charts of 169 patients selected among 306 patients who had underwent LLETZ followed by type 1 extended abdominal hysterectomy from Jan. 1996 to Dec. 2001 at Yonsei University Medical Center were retrospectively reviewed for post-operative morbidity. The patients were categorized into three groups according to time interval: within 48 hours, within 48 hours to 6 weeks, longer than 6 weeks. Correlation of post-operative morbidity and time interval was evaluated. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: There were no significant differences in demographic and obstetric characteristics among three groups. There were no significant differences in operative time (104.3 min, 99.6 min, 102.4 min), blood loss (190 ml, 182 ml, 160 ml), hemoglobin change (1.12 g/dl, 0.92 g/dl, 1.28 g/dl), febrile morbidity (6.7%, 6.8%, 0.0%), wound problems (6.7%, 9.1%, 10.0%) and urinary difficulty (2.9%, 0.0%, 5.0%). CONCLUSION: We found no significant differences in post-operative morbidity according to various time intervals between LLETZ and TAH. It could be recommended for TAH after LLETZ to be performed regardless of the intervening interval because there is no specific suitable time for the patients.

Correlation of post-operative morbidity and various time intervals between large loop excision of transformation zone and total abdominal hysterectomy / 대한산부인과학회잡지

OBJECTIVE: This study was aimed to detail the effects of various time intervals between large loop excision of transformation zone (LLETZ) and total abdominal hysterectomy (TAH) upon post-operative morbidity. METHODS: The charts of 169 patients selected among 306 patients who had underwent LLETZ followed by type 1 extended abdominal hysterectomy from Jan. 1996 to Dec. 2001 at Yonsei University Medical Center were retrospectively reviewed for post-operative morbidity. The patients were categorized into three groups according to time interval: within 48 hours, within 48 hours to 6 weeks, longer than 6 weeks. Correlation of post-operative morbidity and time interval was evaluated. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: There were no significant differences in demographic and obstetric characteristics among three groups. There were no significant differences in operative time (104.3 min, 99.6 min, 102.4 min), blood loss (190 ml, 182 ml, 160 ml), hemoglobin change (1.12 g/dl, 0.92 g/dl, 1.28 g/dl), febrile morbidity (6.7%, 6.8%, 0.0%), wound problems (6.7%, 9.1%, 10.0%) and urinary difficulty (2.9%, 0.0%, 5.0%). CONCLUSION: We found no significant differences in post-operative morbidity according to various time intervals between LLETZ and TAH. It could be recommended for TAH after LLETZ to be performed regardless of the intervening interval because there is no specific suitable time for the patients.