Soo-Ho Chung

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.

Premenstrual syndrome and dysmenorrhea in the career women at Bucheon City

목적: 경기도 부천시 지역의 직장여성들에서 월경전증후군의 유병률을 알아보고, 월경전증후군에 대한 인지도와 의료상담 및 치료의 빈도를 평가하기 위함이다. 연구방법: 월경전증후군에 대한 공개강좌 후 설문지를 통해 5개 기업 289명의 직장여성을 대상으로 조사를 시행하였다. 그 중 답변이 부족한 경우나 다른 질환으로 인한 증상을 배제한 후 170명을 대상으로 월경주기, 규칙성, 월경곤란증의 정도, 진통제 복용여부, 월경전 증상의 빈도, 기간 등을 평가하였다. 건강 강좌 전 월경전증후군에 대한 인지 여부와 상담유무도 조사하였다. 결과: 월경전증후군의 유병률은 세계건강보건기구의 ICD-10에 의한 진단기준으로 74%, 미국산부인과학회의 진단기준으로 38%였다. 월경전 증상은 빈도 순으로 볼 때 더부룩함, 분노나 화남, 체중증가, 잠을 설침, 집중력 장애, 졸림, 오심 구토의 순이었다. 월경전증후군은 월경량이 정상인군에 비해 과량인 군에서 유의하게 증가되어 있었고 월경주기나 월경곤란증의 정도, 진통제 복용 등과는 유의한 상관관계를 보이지 않았다. 연구대상자의 대부분인 94.1%가 월경전증후군에 대해 모르는 상태였고, 6.3% 정도가 의사와의 상담한 병력이 있었다. 결론: 월경전증후군은 매우 흔하며 특히 직장여성들의 직장에서의 활동과 업무에 많은 영향을 끼치고 있다. 그에 반해, 대부분의 직장여성들은 월경전 증상 및 월경전증후군에 대해 정확히 인지하지 못하는 상태로 의학적 상담 및 치료도 거의 이루어지고 있지 않다. 따라서 지속적인 건강 강좌와 교육을 통해 월경전증후군에 대해 알리고 효과적인 의학적 치료를 유도한다면 향후 업무의 효율성을 높이고 삶의 질을 높일 것이라 판단된다.

Presenting features of pyometra including an increase in iatrogenic causes.

A retrospective case series of 14 patients were diagnosed with pyometra for 10 years at our hospital. We reported iatrogenic causes, such as radiofrequency or uterine artery embolization, and other pyometra causes in our hospital to provide guidance for diagnosis by a gynecologist.

Gynecologic complication of chronic graft-versus-host disease: Vaginal obstruction

Allogenic peripheral blood stem cell transplantation (Allo-PBSCT) is being used to treat hematological malignancies with increasing frequency. Graft-versus-host disease (GvHD) is a complex complication of PBSCT. A 43-year-old woman came to the gynecology clinic for amenorrhea. She had been diagnosed with acute myeloid leukemia 2 years earlier and treated with induction and consolidation chemotherapy. After developing complete remission, she underwent Allo-PBSCT. When she started chemotherapy, her menstrual cycle completely disappeared. Fourteen months after menopausal hormone replacement therapy, it was discovered that her upper vaginal canal was completely obstructed. The lower vagina had an atrophic appearance. We report a rare case of partial vaginal obstruction as a complication of chronic GvHD and review the literature. We expect that this case report provides an opportunity to remind clinician of the gynecologic complications of GvHD.

Endosalpingiosis in Postmenopausal Elderly Women

In gynecology, endosalpingiosis is a benign condition in which the fallopian tube-like epithelium is found outside the fallopian tube. The thirty-four point five percent of endosalpingiosis cases have concurrent endometriosis and 40% of the endosalpingiosis group are in postmenopausal states. In contrast with endometriosis, there are no significant links between infertility, chronic pelvic pain and endosalpingiosis. The symptoms of endosalpingiosis are not yet settled. Endosalpingiosis is almost always an incidental finding; it is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and biopsy. Therefore, the clinical differential diagnosis of an intramural mass is more important for clinicians when discussing further surgery with the patients. We report case of woman who has endosalpingiosis and is presented with vaginal bleeding. We first suspect the disease during physical examination. Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. Images show multisepted cystic masses in left adnexa. To rule out the pelvic mass, we executed exploratory laparotomy. Pathologic results show endosalpingiosis near the ovary section. But the endosalpingiosis, is not generally considered a pathology, and thus, no treatment is necessary.

Constipation During Pregnancy When a Typical Symptom Heralds a Serious Disease

A 23-year-old primigravid woman at 14 1/7 weeks of gestation arrived at the emergency department with abdominal pain. Two months earlier, she began having intermittent pain and constipation. She had performed an enema three times and had received intermittent medicated laxatives for 2 months from local clinics. The patient reported having had severe constipation for 7 days 1 year perviously. Her past medical, surgical and family histories were negative. On physical examination, she was 155 cm tall and weighed 38 kg. She had diffuse abdominal tenderness without rebound tenderness. Her bowel sounds were normal. She displayed intermittent colicky pain, which subsided only with opioid treatment. She was treated with stool softeners and laxatives. One day after admission, the patient’s hemoglobin was 9.7 g/dL, hematocrit was 27.1%, and white blood cell count was 9,840/microliter. We prescribed rehydration, electrolyte control, and analgesics for intermittent severe pain. Three days after admission, she developed night fevers (maximum temperature 38°C) and sweating. Considering our differential diagnosis, which included infection and connective tissue disorder, we ordered various other laboratory studies including erythrocyte sedimentation rate; urine culture; hepatitis A, B, and C evaluation; antinuclear antibody testing; and rheumatic factor; all were within normal limits. The C-reactive protein level was elevated to 3.40 mg/dL. We began cefotetan intravenously 4 days after admission; the physician recommended she receive nothing by mouth. Six days after admission, a magnetic resonance imaging scan revealed marked dilatation (6-cm diameter) of the transverse and descending colon (Fig. 1). Seven days after admission, glutamyl oxaloacetic transaminase and glutamyl pyruvic transaminase levels increased to 102 and 134, respectively. Eight days after admission, the C-reactive protein level increased to 11.73 mg/dL, and upper endoscopy revealed gastritis. Colonoscopy revealed multiple colon ulcers, colonic atony, and colonic inertia (Fig. 2). The physician and patient agreed to radiologic studies to evaluate possible colon perforation. An X-ray computed tomography scan revealed a sigmoid colon collapse with fecal content; the transverse colon was 10 cm in diameter, and the colon was dilatated from the cecum to the transverse colon (Fig. 3). No perforation was seen. Ogilvie syndrome (acute colonic pseudo-obstruction) then was suspected. Nine days after admission, we performed a diatrizoate meglumine and diatrizoate sodium (Gastrografin) enema. Rectal and nasogastric tubes were placed for decompression, and erythromycin, piperacillin, and tazobactam were given intravenously. (We did not prescribe neostigmine because it is contraindicated in a setting of gastrointestinal ulcers.) The From the Department of Obstetrics and Gynecology, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea.

Cervical Cancer Screening after Perimenopause: How Is Human Papillomavirus Test Performed?

Cervical cancer is the third most prevalent cancer in women around the world. Recently in Korea, the incidence of cervical cancer has decreased, but in all stages of cervical intraepithelial neoplasia (CIN), CIN has shown a 91% increase from 1999 to 2008. Persistent human papillomavirus (HPV) infection has been found to be the main cause of cervical cancer. HPV types 16 and 18 have been found in 70% of cervical cancer patients around the world. Cervical cancer screening such as cytology has limitations in terms of sensitivity and specificity. A discussion about the need for the HPV test is becoming active in order to compensate for the limitation of cytology. After the role of HPV in cervical cancer was identified, the importance of HPV detection test as a screening was emphasized. Several tests have been developed and each test has its own advantages and disadvantages, and new test method to overcome the disadvantages is still being developed. Todays guidelines and tests are those you would choose from among the large number of cervical cancer screening guidelines and tests, based on the consideration that the selected guidelines and the test are effective.

Change in mental status due to pneumocephalus after regional anaesthesia during obstetrics and gynaecological surgery

A 40-year-old para 1 woman was admitted to a local clinic for evaluation of pelvic inflammatory disease. The woman had undergone four previous operations. She was transferred to a university hospit...

Effect of nalbuphine hydrochloride on the active phase during first stage of labour: A pilot study

The aim of this pilot study was to determine whether nalbuphine shortens the duration of the active phase during the first stage of labour in pregnant women. Among 1,619 deliveries, we enrolled 302 pregnant women between March 2003 and August 2005. The case group received a nalbuphine injection (n = 57), while the remaining patients served as a control group (n = 245). The effects of nalbuphine on the length of labour were analysed using a survival analysis (log-rank test). The average duration of the initial active phase was 75 and 160 min for the case and control groups, respectively. The reduced duration of the active phase in the case group occurred regardless of oxytocin infusion (p < 0.01) and was without significant risks.