Marternal Plasma ADMA Level, Placenta eNOS and Placenta Antioxidant Marker According to the Presence or Absence of Uterine Artery Notch on Color Doppler in the Third Trimester Pregnancies / 대한주산의학회잡지

PURPOSE: We examined pregnancy outcomes and maternal plasma asymmetric dimethylarginine (ADMA) concentrations in the presence or absence of uterine artery notch, and analyzed their relationships to the expression of placental endothelial nitric oxide synthase (eNOS) and antioxidant enzymes, including manganese superoxide dismutase (MnSOD), glutathione peroxidase (GPX), and catalase. METHODS: We assessed uterine artery doppler waveforms in 30 women who had been hospitalized for delivery. Plasma concentrations of ADMA were also measured. Tissue samples of placentas were obtained from 15 patients with diastolic notch and 15 patients without diastolic notch, according to uterine Doppler velocimetry analysis. We evaluated the placental expression of eNOS, MnSOD, GPX and catalase with Western blot analysis and eNOS with immunohistochemistry. RESULTS: The maternal plasma ADMA concentration increased significantly in the group with bilateral Uterine artery notch compared with the group without uterine artery notch (P=0.04). The expression of eNOS in the placenta significantly increased and the expression of MnSOD and GPX decreased significantly in the group with uterine artery notch at the third trimester. CONCLUSION: Uterine artery diastolic notch in pregnant women is associated with high maternal plasma ADMA, increased placental eNOS, and decreased MnSOD and GPX.

Comparison of the Evaluation Results of Faculty with Those of Standardized Patients in a Clinical Performance Examination Experience / 한국의학교육

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.

Clinical study for Patients with Cervical Cancer who had undergone Radical Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to analyze the clinical study for patients with cervical cancer who had undergone radical hysterectomy. METHOD: The subjects of this study were one hundred and sixty two patients with cervical cancer who had undergone radical hysterectomy at Eulji Medical College Hospital, Taejon, Korea, from January 1983 to December 1992. We reviewed the medical record retrospectively and analyzed the data. RESULT: The distribution of patients by age was found in the order of 50 decade and 60 decade, 40 decade. Those by the clinical stages were as follows: Stage Ia, 12 cases(7.4%); Stage Ib, 84 cases(51.9%); Stage IIa, 39 cases(24.1%); Stage IIb 27 cases(16.7%). The results of histopathologic type were distributed as follows: squamous cell carcinoma was 91.9%, adenocarcinoma was 4.9% and adenosquamous cell carcinoma was 3.1%. The histologic subtypes of squamous cell carcinoma(149 cases) were as follows: Large cell non-keratinizing type was 75.9%, large cell keratinizing type was 14.8% and small cell type was 1.2%. The frequancy of lymph node metastasis was 22.9% in stage I and 31.8% in stage II. The overall incidence of lymph node metastasis was 26.4%. The frequency of external radiation therapy done after radical hysterectomy was 63.5% in stage I and 75.8% in stage II. The 5-year survival rate was as follows: The Ia was 100%; Stage Ib, 95.2%(4cases); Stage IIa, 87.2%(5cases); Stage IIb, 77.8%(6cases). The incidence of recurrence was 7.4% and recurrent sites were vaginal stump , rectum and pelvic wall. CONCLUSION: The highest incidence of cervix cancer in age distribution was 50 decade(30.9%) and 60 decade(30.9%). The most common clinical stage was Ib(51.9%) and most frequent pathologic type was squamous cell carcinoma(91.9%). The overall incidence of lymph node metastasis was 26.4% and The most common site of recurrence was vaginal stump. The 5-year survival rate was 100% in the stage Ia, 95.2% in the stage Ib, 87.2% in the stage IIa, 77.8% in the stage IIb.

Evaluation of Methods for Fetal Weight Estimates Using Ultrsound Formula at Term / 대한산부인과학회잡지

A total of 150women with singleton pregnancies who were delivered between 37 and 42weeks gestation had ultrasound scans on elective cesarean section day. The biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC) and femur length(FL) were measured in all cases. Equations of estimated fetal body weight(BWT) for Korean term fetuses using AC alone, BPD/AC, AC/FL, HC/AC/FL, BPD/AC/FL, BPD/HC/AC/FL were made by stepwise multiple regression analysis and were compared with foreign equations such as Campbell(AC), Shepard(BPD/AC), Hadlock I(AC/FL), Hadlock II(HC/AC/FL), Hadlock III(BPD/AC/FL), and Hadlock IV(BPD/HC/AC/FL). The results were as follows. 1. The equations of BWT by sonographic measurement were Equation1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) Equation2 (BPD,AC)logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) Equation3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) Equation4(HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) Equation5(BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. When BPD, AC and FL were measured, the addition of HC didn,t affected to accuracy of EFW 3. The best results of all equations were obtained with our equation 5(Mean error=2.36gm, Mean absolute error=96.39gm, Mean deviation + SD(%)=0.07+0.37) and among foreign equations, the best results were with Hadlock III equation(Mean error=18.35gm, Mean absolute error=107.82gm, Mean deviation + SD(%)=-0.46+0.42) 4. The equations using AC/FL (our equation 3, Hadlock I) are more accurate than those using BPD/AC (our equatione 2, Shepard) when utilizing two parameters. Therefore, equation using AC/FL is recommended when the BPD is unobtainable at term or labor 5. The percentage of cases in which the EFW was within +5% and +200gm of the actual birth weight was highest at our equation 5 for 82% and 89%, Hadlock IV equation for 79%, 88%. 6. Our equations had relatively an equal tendency to under- and overestimate fetal weight, but foreign equations, especially Campbell and Hadlock II equations tended to underestimate. 7. Analysing according to actual birth weight, our all equations gave the most accurate estimates of fetal weigh for birth weight group between 3000-3499gm, but for birth weight group above 3500gm, that was not. At birthweight group above 3500gm, the equations depend on femur length are more accurate than the equations independ on fumr length.

An association between elevated second-trimester human chorionic gonadotropin and subsequent preeclampsia / 대한산부인과학회잡지

OBJECTIVES: The purpose of this investigation was to determine whether women with unexplained elevations of maternal serum human chorionic gonadotropin(hCG) at 14-20weeks gestation are at incresed risk for poor pregnancy outcomes. METHODS: 661 pregnant women undergoing second trimester triple marker screening test for Down syndrome and neural tube defect and delivered at our hospital were reviewed. Of 656 pregnancies that did not have maternal serum alpha feto-protein> or =2.5 multiples of the median(MoM), risk for poor pregnancy outcomes include to preeclampsia, preterm delivery, preterm rupture of membrane(PROM), small for gestational age(SGA) and fetal distress was evaluated in women with elevated hCG(> or =2.0 MoM) compared with women without elevated hCG(<2.0 MoM). RESULTS: Pregnancies with elevated hCG levels were at increased risk for preeclampsia (risk ratio 3.4, 95% confidence interval 1.5-7.6) but elevated hCG levels were not significantly associated with preterm delivery, PROM, and SGA and fetal ditress independent with preeclampsia. CONCLUSION: Pregnancies with elevated second-trimester hCG appear to be at higher risk of subsequent preeclampsia and this finding supports the theory that placental vascular changes that ultimately lead to preeclampsia begin at least by the second trimester. But further studies must be to determine how such information can be used to improve pregnany outcome.