Comparison of Efficacy between MonoPrep(R) and Papanicolaou Smear for Cervical Cancer Screening / 대한산부인과학회잡지

OBJECTIVE: To compare the specimen adequacy and cytologic diagnostic results of MonoPrep(R), a type of liquid based preparation, with the conventional Pap smear. METHODS: In randomly selected 156 patients who visited the department of Obstetrics and Gynecology, Ajou University Hospital for cervical biopsy, conventional Pap smear and matched MonoPrep(R) were performed. Statistical analysis was performed with chi-square test. RESULTS: There were more "Unsatisfactory" and "Satisfactory but limited by (SBLB)" results in the conventional Pap smear group, even though no statistical significance could be found between the two groups. ASC/LSIL ratio was significantly decreased in the MonoPrep(R) group, showing 0.4 with MonoPrep(R) and 1.9 with conventional Pap smear demonstrating a 78.4% decrease (P<0.001). In detecting abnormal cervical lesions, conventional pap smear showed a sensitivity of 87.7%, positive predictability of 82.3%, false negativity of 10.3%, while MonoPrep(R) showed a sensitivity of 94.8% (P=0.04), positive predictability of 97.4% (P<0.001), and false negativity of 2.6% (P=0.016). CONCLUSION: MonoPrep(R) is more effective for the detection of cervical lesions with higher sensitivity and lower false negativity compared to conventional pap smear.

Umbilical Nucleated Red Blood Cell Counts and Perinatal Outcome According to Doppler End-Diastolic Velocity in Severe Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: To assess the umbilical nucleated red blood cell counts and perinatal outcomes according to umbilical artery Doppler end diastolic velocity in severe preeclampsia. MATERIALS AND METHODS: A prospective case-control study comparing 42 severe preeclampsia patients who had present umbilical artery end diastolic velocity with 7 severe preeclampsia patients who absent end diastolic velocity for umbilical nucleated red blood cell counts and perinatal outcomes. RESULTS: Those with absent end diastolic velocity did not have significantly greater nucleated red blood cell counts, but they had increased hemoglobin, hematocrit. These newborn had significantly lower birth weight, increased Cesarean section rate for fetal distress and been more frequently admitted to the neonatal intensive care unit. These newborn also had significantly increased intracranial hemorrhage,assisted ventilation and longer hospital days. CONCLUSION: No correlation with nucleated red blood cell counts and chronic fetal hypoxia were presented. However further study with more expanded cases for the role of nucleated red blood cell counts as a marker of fetal hypoxia will be needed.

Laparoscopic management of ovarian pathologic lesions / 대한산부인과학회잡지

OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of operative laparoscopy in ovarian pathologic lesions. MATERIALS AND METHODS: A retrospective case series which compares 354 patients who had laparoscopic surgery at Ajou University Hospital from June, 1994 to September, 2001 for ovarian pathology. RESULTS: The patient's ages ranged from 13 to 77 years, and their mean age was 30.9 years. Most of the lesions were less than 7 cm in size and unilateral. The operations performed were cystectomy in 225 cases (63.6%), salpingooophorectomy, oophorectomy, salpingectomy and fenestration or biopsy in order. Operative times were between 10 and 240 minutes (mean: 74.2 minutes). Pathologic examinations of unilateral ovarian tumors were performed in 305 cases. The most common pathology of unilateral ovarian tumor was teratoma (107/305, 35.1%), endometrioma and cystadenoma in order. Malignancies were found in 4 cases including borderline malignancy (1.3%). Pathologies of bilateral ovarian tumor were endometrioma (31/41, 75.6%), teratoma, and fibroma in order. Postoperative hospital stays were from 0 days to 19 days (mean: 2.5 days). There were 7 surgical complications including 3 vessel injury related hematomas, 1 abscess formation, and 3 exploratory laparotomy. CONCLUSIONS: We concluded that operative laparoscopy was useful in surgery of ovarian lesions, if there are carefully selected patients, standard procedures, and skilled laparoscopic surgeons.

Clinical outcomes of pregnancy showing one abnormal glucose tolerance test value / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcomes of pregnancies showing one abnormal glucose tolerance test value. Method: We performed 50 gm glucose challenge test in 5,019 pregnant women at 24-28 weeks of gestation. In 1,170 women with plasma glucose levels over 130 mg/dL, 100 gm oral glucose tolerance tests (OGTTs) were performed at 28-32 weeks of gestation. In the 888 cases who were followed up, according to the National Diabetes Data Group (NDDG) criteria, 122 cases with one abnormal 100 gm OGTT value were divided into three groups (groups 1, 2, 3 : abnormal value after 1, 2, 3 hours, respectively). These were compared with 577 cases (control group) with normal 100 gm OGTT value, retrospectively. Result: The incidence of one abnormal glucose tolerance test value was 2.6%, and there were no cases where the fasting plasma glucose level only was elevated. The incidence (control, group 1, group 2, group 3 : 19.4%, 43.8%, 25.7%, 29.6%) of poor maternal outcomes which contain any one of preeclampsia, hydramnios, cesarean delivery for cephalopelvic disproportion or failure to progress or fetal distress was highest in group 1 (p=0.025). The incidence (15.8%, 43.1%, 14.3%, 21.1%) of poor perinatal outcomes which contain any one of fetal distress, Apgar score of 5 minute < 7, hypoglycemia, respiratory distress syndrome, small for gestational age, perinatal death was also highest in group 1 (p=0.009). Logistic regression analysis for poor maternal outcomes showed odds ratio of 2.83 (95% confidence interval 1.02-7.87) in group 1 and 2.08 (95% confidence interval 1.22-3.55) in group 3, and for poor perinatal outcomes odds ratio of 4.24 (95% confidence interval 1.02-17.52) in group 1 and 3.30 (95% confidence interval 1.45- 7.48) in group 3. CONCLUSION: Pregnancies complicated with one abnormal glucose tolerance test value, particularly the group showing abnormal glucose tolerance test value after 1 or 3 hour exhibited adverse maternal and perinatal outcomes.

Apoptosis of human luteinized granulosa cell via change of mitochondria / 대한산부인과학회잡지

OBJECTIVE: To determine the effects of extracellular ATP on mitochondrial function and apoptosis during human luteinized granulosa cell cultures. METHODS: The addition of various concentrations of ATP (0, 0.1, 0.25, 0.5, 0.75 mM) to luteinized granulosa cells obtained during In vitro fertilization ovum pickup procedures. After culture for 24 hours, purinoceptor activity and functional changes in mitochondria were measured by patch clamp, flow cytometry, and confocal microscopy. RESULTS: Measurement by patch clamp of the granulosa cell membrane potential after ATP addition to cultured granulosa cells showed that both the inward and outward currents were expressed. After treatment of the granulosa cells with JC-1, measurement of the mitochondrial activity by confocal microscopy showed that the with increasing concentrations of ATP the relative ratio of undamaged mitochondria (red/green ratio) tended to decrease (P=0.027). After double staining of the cultured granulosa cells with Annexin V and Propidium Iodide, quantitative flow cytometry analysis showed that apoptosis increased with increasing concentrations of ATP (7.88%, 8.44%, 11.40%, 13.52%, 18.57%). CONCLUSION: The results of this study shows that apoptosis of granulosa cells increases with increasing extracellular ATP concentrations in cultured human luteinized granulosa cells. This is observed to be a consequence of cell membrane purinoceptor activity and functional changes in the mitochondria. It is therefore thought that remodelling processes of the ovarian tissue is regulated by neuroendocrine factors of the extracellular ATP.

A Novel Anti-apoptosis Gene, Survivin, Expressed in Uterine Cervical Carcinoma / 대한부인종양콜포스코피학회잡지

OBJECTIVE: Survivin is a novel inhibitor of apoptosis. Suppression of apoptosis is important for carcinogenesis and tumor growth. The purpose of this study was to investigate whether survivin is expressed in the tissues of normal uterine cervix, cervical intraepithelial neoplasia grade III (CIN III) and squamous cell carsinoma of the uterine cervix, as a first step for evaluation of the clinical significance of survivin in uterine cervical cancer. METHODS: We investigated the expression of survivin in the tissues of 11 cases of normal uterine cervix and 14 cases of CIN III and 20 cases of uterine cervical cancer, using Immunohistochemistry at department of obstetrics and gynecology of Ajou university hospital from Jan. 2000 to Jan. 2001 and then compared with the results of three groups. RESULTS: The expression of survivin is increased significantly in cases of CIN III and uterine cervical cancer compared with controls. (p<0.05, One way ANOVA test) CONCLUSION: This study shows survivin could play an important role in the carcinogenesis mechanism of uterine cervix. And further study will be followed to evaluate the clinical relationship of survivin in uterine cervical cancer and whether to act a prognostic factor or not.