Tae Chul Park

Persistence of human papillomavirus as a predictor for treatment failure after loop electrosurgical excision procedure

We aimed to investigate whether postconization human papillomavirus (HPV) DNA testing can predict treatment failure and improve the accuracy of conventional follow-up in women with high-grade cervical intraepithelial neoplasia (CIN). Between March 2001 and October 2005, 120 patients with confirmed CIN 2 or 3 were treated with loop electrosurgical excision procedure (LEEP) and were enrolled. Six patients were lost to the follow-up. Postconization follow-up was performed at every 3–6 months during the first year and then annually. Specimens were tested for the presence of HPV, using the Hybrid Capture 2 (Digene Co, Gaithersburg, MD) and HPV DNA chip (Mygene Co, Seoul, Korea) test. Persistent HPV infection was defined as persistently (two times or more) positive HPV tests with the same HPV subtype(s) at initial diagnosis. Twenty-two (19.3%) patients showed treatment failure after conization. The only significant risk factor for redevelopment of CIN after conization was persistence of the same HPV subtype (P< 0.0001). And women with recurrent or residual CIN had higher HPV load during the 6-month follow-up postconization. In conclusion, the persistence of the same HPV subtype after LEEP conization was an important predictor of treatment failure. The follow-up protocol after conization of CIN should include both cervical cytology and HPV test, and HPV DNA chip test is needed to detect a persistent HPV infection.

A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy

PurposeWe compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications.MethodsWe enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary’s Hospital of Korea from March 2007 through February 2009. We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture.ResultsAll operations were completed successfully by laparoscopy. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248).ConclusionsThe two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.

Association of KIR genes and HLA-C alleles with HPV-related uterine cervical disease in Korean women.

This study investigated whether killer-cell immunoglobulin-like receptor (KIR) genes and human leukocyte antigen (HLA)-C alleles, receptors and ligands of natural killer cells are associated with the development of human papillomavirus (HPV)-related cervical disease in Korean women. Blood samples from 132 women with HPV-related cervical disease and 159 women without HPV infection were collected for genotyping of KIR genes and HLA-C alleles. Although no relationship was found between KIR genes and HPV-related cervical disease, a significant relationship was found between HLA-C alleles as ligands of KIR and HPV-related cervical disease. Women with HPV-related cervical disease were found to be significantly more likely to carry HLA-C*0303, particularly those with HPV 16 or 18 infection, and less likely to carry HLA-C*01 compared to women without HPV infection. HLA-C*0303 was found to confer susceptibility to HPV-related cervical disease, whereas HLA-C*01 was found to confer a protective effect against HPV-related cervical disease.

Duplicated Uterine Arteries in Laparoscopic Hysterectomy

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Vaginal Cuff Closure With Unidirectional Barbed Suture During Total Laparoscopic Hysterectomy is a Safe and Feasible Procedure.

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P02.16: Selective transarterial embolization of uterine arteriovenous malformation complicated in previous Cesarean section scar pregnancy

Different intravenous iron preparations are available and have been successfully utilized in the preoperative management in these cases, but older high molecular weight dextran-based products were cumbersome to use and posed significant risk of anaphylaxis. Newer molecules are currently available and can safely deliver high doses of iron in short periods of time with rapid improvements in hemoglobin levels, thus allowing for more prompt interventions and avoiding or minimizing transfusions of blood products. Intravenous iron replacement in these cases resulted in significant improvements in hemoglobin levels and replenishing of the body iron stores, which allowed to operate under better conditions improving patient’s safety and well-being. The administration of intravenous ferric carboxymaltose represents a valid alternative to current treatment modalities in the perioperative management of moderate to severe iron deficiency anemia.

P35.08: Conservative management combined with H2O2 irrigation of lower uterine segment in a cesarean section scar pregnancy

The incidence of ectopic pregnancy is 2% of all pregnancies and has increased. It is reported that a recurrent ectopic pregnancy rate is 10–15% after salpingotomy compared with 10% after salpingectomy. Corneal pregnancy after ipsilateral total salpingectomy or remnant tubal pregnancy after ipsilateral partial salpingectomy is reported but recurrent ectopic pregnancy in the tubal remnant stump after ipsilateral total salpingectomy is rare and exact incidence is unknown. We present a case of spontaneous ectopic pregnancy occurring in the stump of a remnant fallopian tube following ipsilateral total salpingectomy for an ectopic pregnancy.

Gene expression profiles in squamous cell cervical carcinoma using array-based comparative genomic hybridization analysis

We report a case of a large myometrial dehiscence observed after systemic MTX for a cesarean scar pregnancy. A 41 year old woman with a history of one previous cesarean section was referred to our unit from another ultrasound practice for confirmation and management of a cesarean scar ectopic pregnancy following IVF. At the time of examination the woman was at day 48 of gestation by the date of the embryo-transfer and was asymptomatic. Transvaginal ultrasound showed a gestational sac measuring 12 × 6 × 8 mm implanted within the lower anterior segment of uterine corpus. A yolk sac was visible without embryonic pole. No free fluid was detected. Initial serum hCG was 7890 UI/l and 7771 UI/l at 48 hours (ratio 0.98). She was given intramuscular MTX (50 mg/m2). A second dose of methotrexate was necessary for successful management. Transvaginal ultrasound about 2 months later showed a severe dehiscence of the cesarean scar (see image). The woman underwent laparoscopic surgical repair of this large defect. Even if there is some evidence that cesarean scar pregnancies are more frequent in severely deficient cesarean scars, the clinical significance of these is still unknown. Large studies are needed to prove also the association between severely deficient cesarean scars and uterine rupture.