Dong-Han Bae

Factors associated with HPV persistence after conization in patients with negative margins.

OBJECTIVE The clearance rate of human papillomavirus (HPV) after conization is generally high, although some HPV infections persist. We investigated the factors that affect the clearance of HPV after conization in patients with negative margins. METHODS We retrospectively analyzed 77 patients (mean age 39.9 years, range 25 to 51 years) with CIN 2/3 who underwent loop electrosurgical excision procedure (LEEP) conization with negative margins. All patients had a Pap smear and high-risk (HR) HPV testing using Hybrid Capture II system and HPV DNA chip before conization. We used>/=1 relative light units (RLUs) as the cutoff for persistence of HPV after conization. RESULTS High-risk HPV was detected in 73 of 77 (94.8%) patients before conization. At the 6-months follow-up, the high-risk HPV was eliminated in 60 of 73 (82.2%) patients. The HPV persistence rate after conization was 17.8% (13/73). Univariate analysis showed that persistent HPV infection after conization with negative margins was more likely to occur when the pretreatment viral load was high (RLU/positive control >100 (p=0.027) and the HPV was type 16 (p=0.021). Logistic regression analysis showed that preoperative HPV type 16 infection was the only significant independent factor (p=0.021) for HPV persistence out of age, cytology, punch biopsy histology, HPV viral load, and conization histology. CONCLUSION Conization effectively removes HR-HPV infection. HPV type 16 infection before conization was significantly related to HR-HPV persistence after conization with negative margins. Therefore, patients with HPV 16 infection before conization need to be followed closely.

Random biopsy after colposcopy-directed biopsy improves the diagnosis of cervical intraepithelial neoplasia grade 2 or worse.

Objectives. To evaluate the usefulness of additional random biopsies in the diagnosis of cervical intraepithelial neoplasia grade 2 (CIN 2) or worse (CIN 2+) after colposcopy-directed biopsy. Materials and Methods. A retrospective chart review was performed in 107 women with satisfactory colposcopy results after colposcopy-directed biopsy with random biopsy for abnormal cervical cytological evaluation at Soonchunhyang University Hospital between April 2008 and November 2009. Random biopsies were performed at the cervical squamocolumnar junction in lesion-free quadrants of the cervix. Loop electrosurgical excision procedure conizations were performed in 59 women. Age, referral cytology, lesion size, human papilloma virus (HPV) viral load, and HPV type were analyzed as possible indicators of lesion severity detected using random biopsy. Results. The mean age was 39.3 years (range = 21-72 y), and 96 (89.7%) women were premenopausal. Sixty-three women had CIN 2+; of those, 8 (12.7%) were diagnosed using random biopsies: 6 had high-grade squamous intraepithelial lesions; 1 had low-grade squamous intraepithelial lesions; and 1 had atypical squamous cells of undetermined significance. Lesions diagnosed as CIN 2+ using random biopsies were significantly correlated with high-grade cytology (p <.001) and lesion size (p <.001) but not age (cutoff = 40 years), HPV viral load (cutoff = 300 relative light units; Hybrid Capture 2), or HPV genotype. Of 59 patients who underwent loop electrosurgical excision procedure conization, the disease severity of 9 (15.3%) cases was upgraded 1 or more grades, compared with the punch biopsy results. Conclusions. The detection of CIN 2+, particularly high-grade cytological abnormalities and large lesion size, can be increased by additional random biopsies after satisfactory colposcopy. Loop electrosurgical excision procedure conization can detect lesions not detected by punch biopsy.

P18.15: The usefulness of ovarian volume using 3D vocal transvaginal ultrasound, antral follicle count and age as predictors of menopause in pre- and postmenopausal women

rate of 96.8% (120/124). The patients did not found the procedure especially uncomfortable or painful and reported a high rate of satisfaction (97.3%). There were 3 patients with complications (1.6%). 2 vagal reactions just after the procedure with a quick recovery, and 1 pelvic inflammatory disease treated with antibiotics for a week. Conclusion: Ultrasound-guided extraction of lost intrauterine devices is a simple and safe procedure that may be performed before more invasive measures are attempted.

A case of vaginal delivery in β-thalassemia minor pregnant woman

The thalassemias are a group of autosomal recessive genetic disorders of hemoglobin synthesis. The thalassemias are classifi ed into two main varieties, αand β-, depending on which of the adult globin chain is produced in reduced amounts. The β-thalassemia is the homozygous and heterozygous state, and common in the Mediterranean region. Homozygous β-thalassemia is usually associated with severe anemia. β-Thalassemia minor, the heterozygous state, is characterized by hypochromia, microcytosis and an elevated of HgA2. No treatment is required for thalassemia minor, but it is important to exclude iron defi ciency anemia and postpartum genetic counseling. Recently, β-thalassemia minor keeps rising steadily in Korea due to the increase in international marriges. Recently we have experienced a vaginal delivery in a β-thalassemia minor Vietnam woman associated with mild anemia. We describe this case with a brief review of the literature.

A CASE OF LAPAROSCOPIC TREATMENT OF THE RETROPERITONEAL ECTOPIC PREGNANCY

자궁외임신은 전체 임신의 약 2%를 차지하며, 임신 초기 임신과 관련된 사망률의 대부분을 차지한다. 초기 진단은 주로 베타 사람 융모생식샘 자극호르몬 검사와 초음파로 이루어진다. 난관에 발생하는 빈도가 가장 많고, 그 다음 간질부, 자궁각, 난소, 자궁경부, 제왕절개부위, 그리고 복강에도 발생한다. 후복막에 발생하는 자궁외임신은 매우 드물어, 대개 3,372에서 7,931분만당 1예의 발생빈도를 보이며, 수술 전 진단은 매우 어려우며, 치료는 수술적 제거이다. 내원 3주 전 무월경 5주에 소파수술 후, 갑작스런 질 출혈로 내원한 26세 여성에서 자궁외임신으로 진단 후 메토트렉세이트 다회 요법을 시행 후 실패하여 복강경 통해 후복막에 착상된 자궁외임신으로 최종 진단하여 치료한 매우 드문 예를 경험하여 간단한 문헌 고찰과 함께 보고하는 바이다.

P49.01: Three‐dimensional (3D) volume measurement of the cervix from 8 weeks to 41 weeks' gestation compared to conventional transvaginal cervical length and width

Objectives: To assess the feasibility and diagnostic criteria for vaginal and uterine fistulas using transvaginal pelvic sonography and color Doppler. Methods: We report on nine consecutive cases of vaginal and uterine fistulas (four rectovaginal, three vesicovaginal and two vesicouterine) diagnosed by transvaginal pelvic ultrasound and color Doppler between January 1996 and February 2006. Results: Diagnosis and localization of the fistulas were performed sonographically and confirmed using standard physical, rentgenographic and/or cystoscopic techniques. Seven cases were treated surgically and two were treated conservatively. All treated cases were successful (Table). Sonographic criteria for vesicovaginal fistulas included: (1) delineating a defect in the bladder and vaginal walls, (2) demonstrating passage of urine through the fistula tract (jet phenomenon) using colored Doppler with back flow (from the vagina back to the bladder) upon mechanical compression of the transducer. Criteria for rectovaginal fistulas included a defect in the rectal wall, and visualization of air bubbles passing through the fistula tract.

A case of ruptured gravid uterus at 35 weeks' gestation after cornual resection

임신 중 자궁파열은 드물게 발생하지만, 모성 및 태아사망까지 초래할 수 있는 치명적인 산과적 응급 질환이다. 파열부위의 출혈이 가장 흔한 합병증으로, 자궁파열 시 사망률은 파열 진단시기와 즉각적인 수술에 달려 있기 때문에 자궁파열을 의심할 수 있는 이러한 증상과 징후를 보이는 경우에는 신속한 진단과 처치가 필요하다. 이러한 자궁파열의 가장 흔한 원인은 기존의 제왕절개술 반흔의 파열이며, 다른 원인으로는 태위이상, 분만 2기의 난산, 유도분만, 무통분만, 조기분만과 42주 이후 분만 등이 있다. 저자들은 1년 전 자궁각절제술 시행 후 임신 35주에 조기진통 치료 중 발생한 자궁파열을 경험하여 보고하는 바이다.

A case of treatment using skin flap of recurrent mesh erosion in transobturator tape

생활수준이 높아지면서 과거에는 중요한 질병으로 여기지 않았던 하 부요로의 대표적인 장애인 요실금으로 산부인과를 찾는 환자가 늘어나 면서 치료 지식이 필요하게 되었다. 우리나라의 연구에 의하면 요실금 의 유병률은 22.9%이고, 그 중 복압성 요실금이 64.4%, 절박성 요실금 이 20.8%이며, 다른 보고에는 성인 여성의 45%에서 요실금을 경험하 였다고 한다[1,2]. 이렇게 많은 복압성 요실금의 최근 치료로 경폐쇄공 질테이프술(transobturator tape, TOT)이 가장 각광을 받고 있다. 그러 나, 그 후 합병증의 보고가 계속 이어지고 있다. DeSouza 등[3]이 TOT 후 발생한 내전근의 근염을 보고하면서 해부학적 구조물의 술 후 감염 에 의한 합병증이 처음으로 보고되었고, 국내에서도 TOT 후 테이프의 감염에 인한 합병증에 대한 보고가 있었다[4]. 저자들도 최근 52세 복 압성 요실금 환자에서 TOT 후 반복되는 질 미란을 성형외과와의 협진 에 의해 피부판 이식과 이물질의 충분한 제거를 통해 치료한 1예를 경 험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다.

A case of spindle cell carcinoma of the uterine cervix

Spindle cell carcinoma is a rare variant of squamous cell carcinoma characterized histologically by a biphasic pattern with both squamous and spindle cell component. There is controversy in the histogenesis, biologic behavior, optimal treatment and prognostic factor for tumor. Treatment must be similar for squamous cell carcinoma. With a review of literature, we report a case of a 52-yearold female with spindle cell carcinoma in the uterine cervix, which has been managed by total hysterectomy.

A CASE OF PRIMARY PULMONARY HYPERTENSION DIAGNOSED AT POSTPARTUM

Primary pulmonary hypertension is a rare disorder and rarely present in pregnant woman, but it make high risk of maternal morbidity and mortality. When a woman with subclinical primary pulmonary hypertension is pregnant, physiologic increase in maternal plasma volume aggravates pulmonary pressure cause cardiac arrest and maternal death. We diagnosed primary pulmonary hypertension in parous woman who didn’t present at any symptom during pregnancy but had dyspnea 7 days after preterm vaginal delivery at 30 weeks 6 days. We report this case with brief review of literatures.