Uterine myomas are the most common benign tumors in reproductive aged women. There have been concerns about fertility and obstetric complications in pregnant women with myomas. Currently, maternal age for pregnancy is increasing, and uterine-preserving therapeutic procedures of uterine fibroids such as myomectomy, high-intensity focused ultrasound (HIFU), or uterine artery embolization (UAE) have increased. However, it is unclear whether those treatments can improve fertility and pregnancy outcomes. Recent data suggest that pregnancies after uterus-preserving procedures are associated with obstetric complications such as cesarean section, placenta previa, preterm labor, premature birth, and low birth weight. The biggest obstetric concern in pregnancies after uterine-preserving procedures is uterine rupture during pregnancy, which can threaten the survival of fetuses. Moreover, uterine rupture after myomectomy is more likely to occur before labor onset. Most international guidelines suggest that myomectomy be considered for a woman with uterine myomas who has undergone several unsuccessful in vitro fertilization cycles despite appropriate ovarian response and good-quality embryos or for a woman with symptomatic myomas. In addition, HIFU or UAE treatments are relative contraindications in women with a future pregnancy plan, because there are limited data about associated pregnancy outcomes, and UAE can affect fertility after the procedure. The risks of uterine rupture and of obstetric complications in pregnancies after myomectomy should be discussed in affected women with a future pregnancy plan.

BACKGROUNDS/AIMS: Standard liver volume (SLV) is an important parameter that has been used as a reference value to estimate the graft matching in living donor liver transplantation (LDLT). This study aimed to determine a reliable SLV formula for Korean adult patients as compared with the 15 SLV formulae from other studies and further estimate SLV formula by gender and body mass index (BMI). METHODS: Computed tomography liver volumetry was performed in 1,000 living donors for LDLT and regression formulae for SLV was calculated. Individual donor data were applied to the 15 previously published SLV formulae, as compared with the SLV formula derived in this study. Analysis for confounding variables of BMI and gender was also performed. RESULTS: Two formulae, "SLV (ml)=908.204xBSA-464.728" with DuBois body surface area (BSA) formula and "SLV (ml)=893.485xBSA-439.169" with Monsteller BSA formula, were derived by using the profiles of the 1,000 living donors included in the study. Comparison with other 15 other formulae, all except for Chouker formula showed the mean volume percentage errors of 4.8-5.4%. The gender showed no significant effect on total liver volume (TLV), but there was a significant increase in TLV as BMI increased. CONCLUSIONS: Our study suggested that most SLV formulae showed a crudely applicable range of SLV estimation for Korean adults. Considering the volume error in estimating SLV, further SLV studies with larger population from multiple centers should be performed to enhance its predictability. Our results suggested that classifying SLV formulae by BMI and gender is unnecessary.
Adult* ; Body Mass Index ; Body Surface Area ; Confounding Factors (Epidemiology)* ; Humans ; Liver Transplantation ; Liver* ; Living Donors ; Reference Values ; Tissue Donors ; Transplants

OBJECTIVE: To evaluate the clinical significance of AGUS including histologic results and diagnostic modalities according to menopausal status. METHODS: One hundred and four patients with AGUS were identified. Corresponding biopsies were available for 87 of these cases. The evaluation for histologic results and diagnostic modalities was made according to menopausal status. RESULTS: Among the 87 patients with AGUS, the number of premenopausal and menopausal patients were 46 (52.9%) and 41 (47.1%), respectively. Over all, 70 (80.5%) of 87 patients were found to have important histologic findings and of them, premenopausal and menopausal patients with invasive diseases were 19 (41.3%) and 31 (75.6%) respectively. There were significant differences in pathologic findings between premenopausal and menopausal patients indicating more invasive lesions in menopausal than premenopausal patients (p=0.002). For the evaluation of diagnostic modality, the second arm was significantly more needed for menopausal than premenopausal patients (p=0.018). CONCLUSION: AGUS on pap smear represents a cytologic diagnosis associated with high incidence of underlying preinvasive and invasive lesions, especially in postmenopausal patients. Thus aggressive work-up is recommended to rule out the potential pathologic conditions in endocervix, endometrium and rarely extrauterine lesions such as gastrointestinal, tubal, ovarian or breast in patients otherwise unexplained AGUS after careful first arm work-up.
Arm ; Biopsy ; Breast ; Diagnosis ; Endometrium ; Female ; Humans ; Incidence ; Menopause