Screening and Early Dignosis of Cervical Carcinoma

Incidence and mortality rates for cervical cancer have decreased steadily in developed Western countries since the 1950s largely as the result of widespread cervical screening. It is now accepted dogma that premalignant disease can be detected by conscientious screening and that cervical cancer can be forestalled by therapeutic modalities that preserve reproductive capacity. However cytologic cervical screening alone has not totally eradicated cervical carcinoma nor has it reduced the incidence of cervical intraepithelial neoplasia. We reviewed methodologies most widely used for early detection of cervical cancer in detail with introduction of a new method which should in-crease the effectiveness of the former methods when used additionally.Incidence and mortality rates for cervical cancer have decreased steadily in developed Western countries since the 1950s largely as the result of widespread cervical screening. It is now accepted dogma that premalignant disease can be detected by conscientious screening and that cervical cancer can be forestalled by therapeutic modalities that preserve reproductive capacity. However cytologic cervical screening alone has not totally eradicated cervical carcinoma nor has it reduced the incidence of cervical intraepithelial neoplasia. We reviewed methodologies most widely used for early detection of cervical cancer in detail with introduction of a new method which should in-crease the effectiveness of the former methods when used additionally

Analysis of Term Infants With Significant Respiratory Complications

A group of 33 term infants with significant respiratory complications were compared with 3,194 term infants delivered during the same time period and without respiratory morbidity. Compared with controls, the study group had a higher incidence of antepartum risk factors such as intrautirne growth retardation(12.1% versus 0.41%), postdatism(18.2% versus 2.79%) and intrapartum risk factors such as abnormal FHR(42.$$% verse 3.2%), meconium-stained amniotic fluid(72.7% versus 6.9%). The odds ratio of intrauterine growth retardation for significant respiratory complications is 33.75 and that of postdatism is 7.753. The odds ratio of abnormal FHR for significant respiratory complications is 22.12 and ,that of meconium-stained amniotic fluid is 36.23. Even in the presence of normal intrapartum FHR and 5-minute Apgar scores, infants with meconium-staines amniotic fluid had an indicidence of respiratory complications 7∼8 times higher than those with clear amniotic fluid. Anterpartum risk factors, meconium-stained amniotic fluid, and abnormal FHR identified the fetus at high risk for significant respiratory complications

Preliminary Study of a Morphology Index using Ultrasonography in Ovarian Tumors

To evaluate the usefulness of morphology index using ultrasonography for differentiating benign from malignant ovarian tumors, 36 patients with ovarian tumors were examined from March, 1993 to June, 1993. Thirty patients were premenopausal and 6 patients were postmenopausal. Transabdominal sonographic pelvic images of 36 patients were correlated with histopathology. Of 38 ovaries, 31 had benign tumors (6 mucinous cystadenoma, 7 endometrial cyst, 7 mature cystic teratoma, 3 corpus luteal cyst, 1 parovarian cyst, 1 fibroma, 1 simple cyst) and 7 had malignant tumors. Mean morphology index(MMI±SE) of malignant ovarian tumors, 9.42±0.97 was significantly higher than that of benign ovarian tumors, 4.51±0.36 (P<0.0001). In premenopausal patients, mean morphology index(MMI±SE) of benign and malignant ovarian tumors was 4.44±0.37, and 9.33±1.45, respectively. In postmenopausal patients, the MMI was 5.5±1.5 for benign ovarian tumors and 9.5±1.5 for malignant tumors. In both premenopausal and premenopausal women, there were no ovarian malignancies in tumors with morphology index below 6. This scoring system was useful in distinguishing benign from malignant tumors(specificity 74% and sensitivity 100%). Our result is more sensitive but somewhat less specific than the others. The main source of false positive results were mucinous cystadenoma and mature cystic teratoma, because of large tumor volume and solid 멗. This study is going on with combined use of color Doppler and tumor markers and the further results will be presented.To evaluate the usefulness of morphology index using ultrasonography for differentiating benign from malignant ovarian tumors, 36 patients with ovarian tumors were examined from March, 1993 to June, 1993. Thirty patients were premenopausal and 6 patients were postmenopausal. Transabdominal sonographic pelvic images of 36 patients were correlated with histopathology. Of 38 ovaries, 31 had benign tumors (6 mucinous cystadenoma, 7 endometrial cyst, 7 mature cystic teratoma, 3 corpus luteal cyst, 1 parovarian cyst, 1 fibroma, 1 simple cyst) and 7 had malignant tumors. Mean morphology index(MMI±SE) of malignant ovarian tumors, 9.42±0.97 was significantly higher than that of benign ovarian tumors, 4.51±0.36 (P<0.0001). In premenopausal patients, mean morphology index(MMI±SE) of benign and malignant ovarian tumors was 4.44±0.37, and 9.33±1.45, respectively. In postmenopausal patients, the MMI was 5.5±1.5 for benign ovarian tumors and 9.5±1.5 for malignant tumors. In both premenopausal and premenopausal women, there were no ovarian malignancies in tumors with morphology index below 6. This scoring system was useful in distinguishing benign from malignant tumors(specificity 74% and sensitivity 100%). Our result is more sensitive but somewhat less specific than the others. The main source of false positive results were mucinous cystadenoma and mature cystic teratoma, because of large tumor volume and solid 멗. This study is going on with combined use of color Doppler and tumor markers and the further results will be presented

Combined Use of CA 15-3 and TAG 72 in Patients with Elevated Serum CA 125 Levels for Discriminating Malignant from Benign Ovarian Masses

The purpose of our study was to evaluate whether the combined use of serum tumor markers, CA 15-3 and TAG 72 could improve the efficacy for discriminating malignant from benign ovarian masses in patients with elevated serum CA 125 levels. Serum CA 15-3 and TAG 72 were preoperatively measured by immunoradiometric assay in 78 patients with pelvic masses who had elevated serum CA 125 levels above 35 U/ml. In 32 patients with epithelial ovarian cancers, serum CA 125 levels were elevated above 65 U/ml in 97% and serum CA 15-3(>30U/ml) and TAG 72(>10 u/ml) levels were elevated in 59% and 50%, respectively, suggesting relatively low sensitivity of CA 15-3 and TAG 72. However, in 41 patients with benign ovarian tumors, elevations of these two markers were detected only in 7% and 5%, respectively, and particularly, both markers were not elevated among all the aptients over 50 years of age. Coordinate elevations of CA 125(>35U/ml) and CA 15-3(>30U/ml) or TAG 72(>10 U/ml) could discriminate epithelial ovarian cancers from benign masses with a sensitivity of 72% and specificity of 90%. Among patients over 50 years of age, sensitivity and specificity were increased to 79% and 100%, respectively. It is concluded that the combined use of CA 15-3 and TAG 72 with CA 125 could obtain an improved efficacy for discrimination of epithelial ovarian cancer, especially among patients over 50 years of age.The purpose of our study was to evaluate whether the combined use of serum tumor markers, CA 15-3 and TAG 72 could improve the efficacy for discriminating malignant from benign ovarian masses in patients with elevated serum CA 125 levels. Serum CA 15-3 and TAG 72 were preoperatively measured by immunoradiometric assay in 78 patients with pelvic masses who had elevated serum CA 125 levels above 35 U/ml. In 32 patients with epithelial ovarian cancers, serum CA 125 levels were elevated above 65 U/ml in 97% and serum CA 15-3(>30U/ml) and TAG 72(>10 u/ml) levels were elevated in 59% and 50%, respectively, suggesting relatively low sensitivity of CA 15-3 and TAG 72. However, in 41 patients with benign ovarian tumors, elevations of these two markers were detected only in 7% and 5%, respectively, and particularly, both markers were not elevated among all the aptients over 50 years of age. Coordinate elevations of CA 125(>35U/ml) and CA 15-3(>30U/ml) or TAG 72(>10 U/ml) could discriminate epithelial ovarian cancers from benign masses with a sensitivity of 72% and specificity of 90%. Among patients over 50 years of age, sensitivity and specificity were increased to 79% and 100%, respectively. It is concluded that the combined use of CA 15-3 and TAG 72 with CA 125 could obtain an improved efficacy for discrimination of epithelial ovarian cancer, especially among patients over 50 years of age

Comparison of Clinical Outcome between Nafarelin and Triptorelin in Controlled Ovarian Hyperstimulation for In Vitro Fertilization: A Randomized Clinical Trial

Gonadotropin-releasing hormone agonists(GnRH-a) vary in structure and route of administration. We performed this study to compare patient response to intranasal nafarelin acetate versus subcutaneous triptorelin as adjuncts to ovulation induction for in vitro fertilization(IVF). From October 1995 to May 1996, sixty-four patients with tubal factor infertility entering their 79 cycles of IVF were randomized to receive either intranasal nafarelin acetate(Group Ⅰ, 38 cycles) or subcutaneous triptorelin(Group Ⅱ, 41 cycles). Controlled ovarian hyperstimulation(COH) using luteal long protocol of GnRH-a was used in all patients. Patient characteristics in the two groups did not differ significantly, nor did sperm parameters or endocrine profiles. There was no significant difference in ovarian response as indicated by duration of GnRH-a administration before ovarian stimulation, number of ampules of gonadotropin used and duration of gonadotropin administration in ovarian stimulation, and serum E( ) level and number of follicles(≥14mm) on the day of hCG administration between the two groups. There were no significant differences in clinical results of oocyte and embryo obtained such as number of oocytes retrieved, oocytes fertilized, embryos cleaved, embryos frozen, and embryos transfered between the two groups. There were also no significant differences between group Ⅰ and group Ⅱ in clinical pregnancy rate(31.6% versus 34.1%) and abortion rate per clinical pregnancy(8.3% versus 14.3%). This study suggests that intranasal nafarelin acetate as well as subcutaneous triptorelin can be used successfully in ovulation induction using luteal long protocol of GnRH-a.Gonadotropin-releasing hormone agonists(GnRH-a) vary in structure and route of administration. We performed this study to compare patient response to intranasal nafarelin acetate versus subcutaneous triptorelin as adjuncts to ovulation induction for in vitro fertilization(IVF). From October 1995 to May 1996, sixty-four patients with tubal factor infertility entering their 79 cycles of IVF were randomized to receive either intranasal nafarelin acetate(Group Ⅰ, 38 cycles) or subcutaneous triptorelin(Group Ⅱ, 41 cycles). Controlled ovarian hyperstimulation(COH) using luteal long protocol of GnRH-a was used in all patients. Patient characteristics in the two groups did not differ significantly, nor did sperm parameters or endocrine profiles. There was no significant difference in ovarian response as indicated by duration of GnRH-a administration before ovarian stimulation, number of ampules of gonadotropin used and duration of gonadotropin administration in ovarian stimulation, and serum E( ) level and number of follicles(≥14mm) on the day of hCG administration between the two groups. There were no significant differences in clinical results of oocyte and embryo obtained such as number of oocytes retrieved, oocytes fertilized, embryos cleaved, embryos frozen, and embryos transfered between the two groups. There were also no significant differences between group Ⅰ and group Ⅱ in clinical pregnancy rate(31.6% versus 34.1%) and abortion rate per clinical pregnancy(8.3% versus 14.3%). This study suggests that intranasal nafarelin acetate as well as subcutaneous triptorelin can be used successfully in ovulation induction using luteal long protocol of GnRH-a

Effects of peroxides and preeclamptic sera on prostaglandin release by perfused human umbilical cord vein

Objective This study was performed to evaluate the prostaglandin secretion rates in human umbilical vein with preeclamptic sera and peroxide perfusion. Study design Isolated human umbilical cords(n=10) were perfused for 30-minute intervals with cord buffer, 15% normal pregnant sera and preeclamptic patient sera, 100 mol/L t-butyl hydroperoxide alone, and after perfusion with low-dose aspirin(5×10( )mol/L). Cord buffer gassed with 95% oxygen and 5% carbon dioxide and warmed to 37℃ was used for the perfusion buffer. Effluent flow rates were measured during each experimental treatment. Effluent samples were measured for 6-keto prostaglandin Flα and thromboxane B( ) by enzyme immunoassays. Results The concentrations of 6-keto prostaglandin F( )α in preeclamptic sera were significantly higher than those in normal pregnant sera.(989.3849 ± 1602.927 vs. 1.3116 ± 1.22085 ng/ml, mean ± SD, p<0.01). However, the concentrations of thromboxane B( ) were not different between normal pregnant sera and preeclamptic sera. The secretion rate of 6-keto-prostaglandin F( )α in human umbilical endothelial cells was not significantly different(p=0.77) between two groups. Comparing to normal pregnant sera, the secretion rate of thromboxane B( ) was significantly increased(p<0.01) after preeclamptic sera perfusion. The secretion rate of 6-keto-prostaglandin F( ) was significantly increased(p<0.01) following peroxide perfusion and that was significantly decreased by aspirin. The secretion rate of thromboxane B( ) was not significantly different between preeclamptic sera and peroxide alone or subsequent perfusion with aspirin. Conclusions (1) Preeclamptic sera stimulate thromboxane production rather than prostacyclin production by endothelial cells of human umbilical vein in vitro. (2) Peroxide stimulates the secretion of both prostacyclin and thromboxane, and low dose aspirin mitigates hydroperoxide-induced prostacyclin secretion. We confirmed that thromboxane secretion is stimulated by preeclamptic sera and the role of peroxide in prostaglandin secretion. We established the perfusion system using human umbilical vein through this study. This perfusion system may be useful to understand the pathophysiology of preeclampsia.Objective This study was performed to evaluate the prostaglandin secretion rates in human umbilical vein with preeclamptic sera and peroxide perfusion. Study design Isolated human umbilical cords(n=10) were perfused for 30-minute intervals with cord buffer, 15% normal pregnant sera and preeclamptic patient sera, 100 mol/L t-butyl hydroperoxide alone, and after perfusion with low-dose aspirin(5×10( )mol/L). Cord buffer gassed with 95% oxygen and 5% carbon dioxide and warmed to 37℃ was used for the perfusion buffer. Effluent flow rates were measured during each experimental treatment. Effluent samples were measured for 6-keto prostaglandin Flα and thromboxane B( ) by enzyme immunoassays. Results The concentrations of 6-keto prostaglandin F( )α in preeclamptic sera were significantly higher than those in normal pregnant sera.(989.3849 ± 1602.927 vs. 1.3116 ± 1.22085 ng/ml, mean ± SD, p<0.01). However, the concentrations of thromboxane B( ) were not different between normal pregnant sera and preeclamptic sera. The secretion rate of 6-keto-prostaglandin F( )α in human umbilical endothelial cells was not significantly different(p=0.77) between two groups. Comparing to normal pregnant sera, the secretion rate of thromboxane B( ) was significantly increased(p<0.01) after preeclamptic sera perfusion. The secretion rate of 6-keto-prostaglandin F( ) was significantly increased(p<0.01) following peroxide perfusion and that was significantly decreased by aspirin. The secretion rate of thromboxane B( ) was not significantly different between preeclamptic sera and peroxide alone or subsequent perfusion with aspirin. Conclusions (1) Preeclamptic sera stimulate thromboxane production rather than prostacyclin production by endothelial cells of human umbilical vein in vitro. (2) Peroxide stimulates the secretion of both prostacyclin and thromboxane, and low dose aspirin mitigates hydroperoxide-induced prostacyclin secretion. We confirmed that thromboxane secretion is stimulated by preeclamptic sera and the role of peroxide in prostaglandin secretion. We established the perfusion system using human umbilical vein through this study. This perfusion system may be useful to understand the pathophysiology of preeclampsia

The Comparison of Platelet Indices between Normal Pregnancy and Severe Preeclampsia

The purpose of this retrospective study was to define platelet indices in severe preeclampsia(N=98) and to compare them to normal nonpregnant values(N=93) during the years 1990-1993 in the Department of Obstetrics and Gynecology, College of medicine, University of Ulsan, Asan Medical Center. Indices evaluated included platelet count, mean platelet volume, and platelet distribution width. Means platelet volume was statistically different between two groups, however mean platelet count was significantly decreased(p=0.029) and platelet distribution width was significantly increased(p=0.0001) and platelet distribution width was significantly increased(p=0.0001) in severe preeclampria. Mean platelet volume versus platelet count in normal pregnancy showed a significant inverse nonlinear relationship(r=-0.39, 9<0.001) and that in preeclampsia was congruent with notmal nonpregnant valus. With same mean platelet volume, platelet distribution width showed tendency to shift to right in severe preeclampsia. These findings support the concept of severe preeclampsia as a compensated state of increased platelet comsumption comparing with normal pregnancy. We concluded from above results that quantification of platelet indices may have some value in screening for and following severe preeclampsia.The purpose of this retrospective study was to define platelet indices in severe preeclampsia(N=98) and to compare them to normal nonpregnant values(N=93) during the years 1990-1993 in the Department of Obstetrics and Gynecology, College of medicine, University of Ulsan, Asan Medical Center. Indices evaluated included platelet count, mean platelet volume, and platelet distribution width. Means platelet volume was statistically different between two groups, however mean platelet count was significantly decreased(p=0.029) and platelet distribution width was significantly increased(p=0.0001) and platelet distribution width was significantly increased(p=0.0001) in severe preeclampria. Mean platelet volume versus platelet count in normal pregnancy showed a significant inverse nonlinear relationship(r=-0.39, 9<0.001) and that in preeclampsia was congruent with notmal nonpregnant valus. With same mean platelet volume, platelet distribution width showed tendency to shift to right in severe preeclampsia. These findings support the concept of severe preeclampsia as a compensated state of increased platelet comsumption comparing with normal pregnancy. We concluded from above results that quantification of platelet indices may have some value in screening for and following severe preeclampsia