OBJECTIVE: To assess the association with autoimmune endocrine diseases and detection rate of autoimmune antibodies and its clinical significance in patients with premature ovarian failure. METHODS: Twenty eight patients with primary or secondary amenorrhea manifesting hormonal and clinical features of premature ovarian failure (primary POF: 7, secondary POF: 21) were investigated. We tested them TFT, 75 g OGTT, ACTH and S-cortisol for thyroiditis, IDDM, Addison's disease, and antithyoglobulin antibody, antimicrosomal antibody, antinuclear antibody, rheumatic factor, anti-smooth muscle antibody, anti-acetylcholine receptor antibody for non-organ specific autoimmune disorders. RESULTS: Only one patient was diagnosed as IDDM and no patients had abnormal TFT or adrenal function test. More than one kind of autoantibody was detected in 11 patients of all (39.2%): 5 patients (71.4%) of primary POF group and 6 patients (21.4%) of secondary POF group. Eleven patients (39.3%) had antithyroglobulin antibody, 4 (14.3%) had antimicrosomal antibody, 2 (7.1%) had antinuclear antibody, 2 (7.1%) had rheumatic factor, 1 (3.6%) had anti-smooth muscle antibody, 1 (3.6%) had anti-acetylcholine receptor antibody. CONCLUSIONS: Premature ovarian failure may occur as a component of an autoimmune polyglandular syndrome, so patients should be measured with free thyroxine, thyroid-stimulating hormone, fasting glucose and electrolytes. Measurement of thyroid autoantibodies in POF patients may be important in identifying patients at risk of developing overt hypothyoidism, but other autoantibodies may not be suitable for screening test.
Addison Disease ; Adrenocorticotropic Hormone ; Amenorrhea ; Antibodies ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases* ; Diabetes Mellitus, Type 1 ; Electrolytes ; Endocrine System Diseases ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Mass Screening ; Primary Ovarian Insufficiency* ; Thyroid Gland ; Thyroiditis ; Thyrotropin ; Thyroxine

No abstract available.
Cloning, Molecular* ; DNA* ; Helicobacter pylori* ; Helicobacter* ; Sequence Analysis, DNA* ; Urease*

OBJECTIVE: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination. METHODS AND MATERIAL: Total 219 infertile patients were retrospectively analyzed between January 1, 2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal. RESULTS: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity 88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II). CONCLUSION: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.
Endometrial Hyperplasia ; Endometriosis ; Fallopian Tube Diseases ; Female ; Female* ; Humans ; Hysterosalpingography* ; Hysteroscopy ; Incidence ; Infertility ; Infertility, Female* ; Laparoscopy ; Polyps ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Infertile women with chronic anovulation are prone to be exposed to unopposed estrogen stimulation and have the high risk of being suffering from endometrial hyperplasia or even endometrial carcinoma. A few reports have suggested that nulliparous young women (under 40 yr of age) with endometrial carcinoma could be treated conservatively to preserve fertility and succeed the live birth. We report on a 36-yr-old woman who received conservative treatment of endometrial carcinoma (stage I, grade 1) by curettage and progestin. After megestrol medication of total 71,680 mg during 24 weeks, we found the regression of endometrial lesion by curettage and hysteroscopic examination. Then we decided to perform in vitro fertilization program. Two embryos were transferred and heterotypic pregnancy was diagnosed 27 days after embryo transfer. After right salpingectomy, she received routine obstetrical care and delivered by cesarean section at 38 weeks in gestational periods. Two years after delivery, she is healthy without any evidence of recurrent disease. The fertility preserving treatment is an option in endometrial cancer patients if carefully selected, and assisted reproductive technologies would be helpful.
Progestins/therapeutic use ; Pregnancy Outcome ; Pregnancy ; Live Birth ; Humans ; Fertilization in Vitro/*methods ; Female ; Endometrial Neoplasms/surgery/*therapy ; Adult ; Adenocarcinoma/surgery/*therapy

OBJECTIVE: To assess diagnostic accuracy of the transvaginal ultrasonography and confirm the clinical safety as a final diagnosis in the asymptomatic ectopic pregnancy. METHODS: Total 58 women which were suspected with ectopic pregnancy were recruited during 1 year period. Women without sonographic evidence of the intrauterine gestational sac with serum beta-hCG level beyond 1,500 mIU/ml or gestational periods beyond 37 days were included (n=44), and women with acute symptom were excluded (n=14). We performed the laparoscopy and compared them with the ultrasonographic findings. We regarded the cases with accordance between two findings as an accurate diagnosis, and calculated diagnostic accuracy. All surgical specimens were confirmed by the pathological examination. RESULTS: Of 44 subjects, we suspected ectopic pregnancy by ultrasonography in 42 patients and classified as right fallopian tube (20 cases), left fallopian tube (15 cases), right interstitial (3 cases), left interstitial (4 cases), normal finding (2 cases). Of 42 cases, 41 cases were confirmed as an ectopic pregnancy by laparoscopical and pathological examination. There were two cases of inaccurate diagnosis, in one case, suspected site was not concordant, in another case, ectopic pregnancy focus was not identified in laparoscopy. In 2 cases with normal ultrasonographic findings, any other findings suspicious of ectopic pregnancy were not identified in laparoscopy. By 2X2 contingency table analysis, sensitivity, specificity, positive predictive value, negative predictive value of the transvaginal ultrasonography for diagnosis of the ectopic pregnancy were 100%, 50%, 98%, 100%, respectively. CONCLUSION: Diagnostic capability of the transvaginal ultrasonography in the ectopic pregnancy was very powerful and reliable, and sonographical diagnosis may replace the diagnostic laparoscopy if medical treatment is intended.
Pregnancy ; Female ; Humans ; Predictive Value of Tests

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.
Cicatrix* ; Female ; Fertility ; Gestational Age ; Hematoma ; Humans ; Methotrexate* ; Parity ; Pregnancy* ; Retrospective Studies

OBJECTIVE: To evaluate the efficacy and prognostic factors of methotrexate treatment in cervical/previous cesarean scar pregnancy. METHODS: This study was retrospectively performed in 25 women who had diagnosed cervical/previous cesarean scar pregnancy. Clinical and demographic characteristics, methotrexate regimen, concomitant invasive procedures, complications, and outcomes were analyzed. RESULTS: Among the 25 cases, 64% of women was succeeded by only methotrexate injection, and 96% of women could preserved her fertility after concomitant procedures. There were no significant differences in the patients' age, parity, gestational age and serum beta-hCG, but significant differences in methotrexate administration route and presence of initial hematoma formation between success group and failure group of methotrexate therapy. A concomitant feticide could enhance the therapeutic effect. CONCLUSIONS: The presence of hematoma formation before treatment is important predictor of methotrexate treatment in cervical/previous cesarean scar pregnancy, rather than gestational age, serum beta-hCG. And direct local injection of methotrexate with concomitant feticide procedure could be better route of administration in cervical/previous cesarean scar pregnancy.
Cicatrix* ; Female ; Fertility ; Gestational Age ; Hematoma ; Humans ; Methotrexate* ; Parity ; Pregnancy* ; Retrospective Studies

Patent urachus results when there is a persistence of an allantosis remnant which normally undergoes atresia during embryological development. Failure of urachal obliteration may result in 4 different types of urachal remnants: complete patency or vesicoumbilical fistula, vesicourachal diverticulum, urachal sinus and urachal cyst. In prenatal ultrasound, we found a large cyst in the umbilical cord. At term, the patient underwent primary cesarean section with delivery of a 3100 g female infant. After delivery, we found the communication of urinary bladder by fistulogarm. The infant underwent repair and closure of the patent urachus.
Cesarean Section ; Diverticulum ; Female ; Fistula ; Humans ; Infant ; Pregnancy ; Ultrasonography ; Umbilical Cord ; Urachal Cyst ; Urachus* ; Urinary Bladder

Implantation of a gestational sac within a previous cesarean scar is the rarest form of ectopic pregnancy. A delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity due to severe hemorrhage. As developing of transvaginal ultrasound and MRI, early diagnosis could be made and conservative treatment could be possible. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, and enabled the successful treatment to preserve the patient's reproductive capability.
Cesarean Section ; Cicatrix* ; Diagnosis ; Early Diagnosis ; Female ; Gestational Sac ; Hemorrhage ; Hysterectomy ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography ; Uterine Rupture

OBJECTIVE: The aim of this study was to expect the possibility of developing fetal thrombocytopenia by observation of the clinical features of pregnant women with ITP and their neonates, and to know the effect of steroid and IVIG therapy. METHODS: The patient group was 21 cases of pregnancies with ITP diagnosed by Bone marrow biopsy or suspective to have ITP due to thrombocytopenia (150 K/micro L) not complicated by sepsis, preeclampsia or massive bleeding resulting DIC, who were admitted and delivered at Dongsan Medical Center, Keimyung University from Jul. 1998 to Jun. 2002. The study was performed retrospectively. We defined severe thrombocytopenia as less than 70 K/micro L and treated them with Prednisolone or IVIG during pregnancy and Platelet concentrate in some perinatal condition. On admission, we performed a history taking about splenectomy etc., antiplatelet antibody test and serial follow up of CBC, coagulation test during perinatal period. We used Fisher's exact test to detect statistical significance between clinical features of pregnancy women with ITP and severe neonatal thrombocytopenia and concluded to be significant if p-value was less than 0.05. RESULTS: The delivery mode of pregnancies with ITP was Cesarean section for 9 cases and vaginal delivery for 12 cases. The decision was purely dependant on obstetric indication. Because there was no significant bleeding during prenatal period even among the women with severe thrombocytopenia, they were treated with steroid in 8 cases followed by IVIG in 1 case, only IVIG in 1 case under no transfusion of Platelet concentrate. Platelet count was not normalized completely but increased over 100% in 7 cases and there was no response in only 1 case. Soon after delivery, neonatal thrombocytopenia was seen in 2 cases (9.5%). There was no ecchimosis or intracranial hemorrhage in spite of vaginal delivery in both cases. CONCLUSION: There were no prospective factors to predict the relationship between the clinical features of pregnant women with ITP and fetal thrombocytopenia. Most of the cases in which steroid therapy was done did not show neonatal thrombocytopenia but there was no statistical significance. There needs to be further study with much more cases.
Biopsy ; Blood Platelets ; Bone Marrow ; Cesarean Section ; Dacarbazine ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Immunoglobulins, Intravenous ; Infant, Newborn ; Intracranial Hemorrhages ; Platelet Count ; Pre-Eclampsia ; Prednisolone ; Pregnancy* ; Pregnant Women ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Sepsis ; Splenectomy ; Thrombocytopenia ; Thrombocytopenia, Neonatal Alloimmune*