OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol(PGE1) versus dinoprostone(PGE2) for labor induction in a prospective controlled trial. METHOD: One hundred eleven patients for labor induction (including preterm rupture of membranes) were randomly assigned to receive either misoprostol 50microgram or dinoprostone 3mg intravaginally. The interval of doses was 8 hours after first dose, with a potential maximum of six dose until active labor pain was achieved. RESULTS: Among 111 patients enrolled, 55 were randomized to receive misoprostol 50microgram and 56 to receive dinoprostone 3mg with every 8 hours interval intravaginally. There were no significant differences in demographic characteristics except in Bishop score(3.81+/-1.52 vs 4.38+/-1.29, P<0.05). There were no significant differences in indications for labor induction. The interval of induction to delivery was shorter in the misoprostol group(750.8+/-518.8min) than in the dinoprostone group(1264.1+/-730.7min). Delivery within 24 hours after administration occurred more often in the misoprostol group than in the dinoprostone group (86.3% vs 65.2%, P<0.05). More than two doses for completion of delivery were frequent in dinoprostone group(36.96% vs 9.8% in misoprostol group, P<0.05). Additional Oxytocin augmentation was needed more commonly in the misoprostol group(3.64%) than in the dinoprostone group(14.29%)(P<0.05), but no significant differences were noted between two groups in total oxytocin doses and indications. Tachysystole occurred more often in the misoprostol group (12.73% vs 1.79% in the dinoprostone, P<0.05) Precipitating delivery occurred more commonly in the misoprostol group(21.82% vs 7.14% in the dinoprostone group, P<0.05). No differences in the cesarean section rate, fetal heart rate abnormalities, hyperstimulation syndrome, meconium staining, fetal outcome (Apgar score at 1 and 5 minutes, birth weight), and marternal outcome (nausea and vomitting, postpartum bleeding) were noted. The cost of misoprosl is one hundredth cheaper than dinoprostone. There was no significant differences in the fetal outcome and maternal outcome. CONCLUSION: These results suggest that intravaginal misoprostol(PGE1) is a safe drug for labor induction which is more effective and cheaper compare to intravaginal dinoprostone(PGE2).
Alprostadil* ; Cesarean Section ; Dinoprostone* ; Female ; Heart Rate, Fetal ; Humans ; Labor Pain ; Meconium ; Misoprostol* ; Oxytocin ; Parturition ; Postpartum Period ; Pregnancy ; Prospective Studies ; Rupture

OBJECTIVE: To report our clinical outcome on 160 cases of laparoscopically assisted vaginal hysterectomy (LAVH) and to evaluate the efficacy and safety of LAVH. METHODS: From May, 1998 to April 2004, 160 patients were performed LAVH at the Department of Obstetrics and Gynecology, Dankook University Hospital. We retrospectively analyzed the results with regard to age, parity, height, weight, previous operation history, preoperative indication, combined operation, operation time, uterine weight, change of hemoglobin, hospitalization, convert to total abdominal hysterectomy (TAH), and complication. RESULTS: The mean age was 44.63 +/- 6.79 years, The mean parity was 2.34 +/- 1.18. The common previous operations were tubal ligation (54%) and appendectomy (17%). The common preoperative indications were myoma (75%) and adenomyosis (10%). The most common combined operation was unilateral salpingoophorectomy (39%). The mean operation time was 97.81 +/- 29.90 minutes, and the mean uterine weight was 215.59 +/- 89.97 g. The mean hemoglobin change was 2.08 +/- 1.34 g/dL, and the mean hospitalization was 4.45 +/- 0.71 days. The complications were bladder injury (1 case), rectum injury (1 case), subcutaneous hematoma (2 cases), hemoperitoneum (1 case). CONCLUSION: LAVH is effective and safe alternative to TAH in many cases of gynecologic surgery. LAVH has been possible to replace TAH with improvement of surgical skill and laparoscopic instruments.
Adenomyosis ; Appendectomy ; Female ; Gynecologic Surgical Procedures ; Gynecology ; Hematoma ; Hemoperitoneum ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Myoma ; Obstetrics ; Parity ; Rectum ; Retrospective Studies ; Sterilization, Tubal ; Urinary Bladder

Uterine sarcomas are relatively rare tumors of mesodermal origin that constitute 2-6% of uterine malignancies. Uterine sarcomas include endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), malignant mixed m llerian tumor (MMMT) of both homologous and heterologous type, pure heterologous sarcomas, blood vessel sarcomas, and lymphoma. Endometrial stromal tumors are divided into three types: 1) endometrial stromal nodule, 2) low-grade stromal sarcoma or endolymphatic stromal myosis, and 3) endometrial stromal sarcoma. The low grade endometrial stromal sarcoma is very rare. It shows occasional local recurrence, which might arise from endometrial stroma, from adenomyosis, and rarely from endometriosis. We have experienced a case of low grade endometrial stromal sarcoma of the uterus in a 54-year-old woman, which is presented with a review of literatures.
Adenomyosis ; Blood Vessels ; Endometrial Stromal Tumors ; Endometriosis ; Female ; Humans ; Leiomyosarcoma ; Lymphoma ; Mesoderm ; Middle Aged ; Recurrence ; Sarcoma ; Sarcoma, Endometrial Stromal* ; Uterus*

OBJECTIVE: To evaluate Fragile histidine triad (Fhit) and p53 expression pattern in cervical intraepithelial neoplasm (CIN) and invasive cervical cancer, and to verify the correlation between the loss of Fhit and clinicopathological parameters of invasive cervical carcinoma and the relationship between Fhit and p53 expression. METHODS: 10 low-grade squamous intraepithelial lesions (LSIL), 16 high-grade squamous intraepithelial lesions (HSIL), and 21 invasive cervical carcinomas were evaluated by immunohistochemical staining for Fhit and p53 primary antibody. Their expression patterns in CIN and invasive cervical cancer were analysed semiquantitatively as positive and negative by the staining area and intensity. Clinicopathological data were obtained by review of patients' hospital records. RESULTS: Compared with CIN (LSIL and HSIL), invasive cervical carcinoma showed significantly loss of Fhit expression (p<0.05). P53 expression did not show the significant difference between CIN and invasive cervical cancer. There was no relationship between loss of Fhit and p53 expression in CIN and invasive cervical cancer. But loss of Fhit expression in invasive cervical cancer was also significantly associated with FIGO stage (p<0.05). CONCLUSION: Our results suggest that loss of Fhit expression may play an important role in the malignant transformation of CIN to invasive cancer. However, further molecular studies are needed to elucidate the role of Fhit gene in the carcinogenesis of cervical cancer.
Carcinogenesis ; Cervical Intraepithelial Neoplasia* ; Histidine ; Hospital Records ; Uterine Cervical Neoplasms*

An unusual case of homicide of a 21-year-old man who was smothered with a hot steam towel by his mother and a pastoress in the name of exorcism. Homicidal smothering in adults is rare, but does occur when the victims are not capable of defending themselves in situations such as chronic illness, old age, drug intoxication or when restrained by other people. In this case, distinct facial scalding was a clue to smothering with a hot steam towel.
Adult ; Chronic Disease ; Homicide ; Humans ; Mothers ; Steam

OBJECTIVES: To evaluate the association between body mass index (BMI) and hemorrhagic stroke. METHODS: A case-control study was conducted on 2,712 persons (904 cases, 904 hospital controls, and 904 community controls) participating in an Acute Brain Bleeding Analysis study from October 2002 to March 2004. Two controls for each case were matched according to age and gender. The information was obtained by trained interviewers using standardized questionnaire. A conditional logistic regression model was used to estimate the association between BMI and the frequency of having a hemorrhagic stroke. RESULTS: Obese men (25.0 < or = BMI < 30.0 kg/m2) had an odds ratios (OR) of 1.39 (95% CI 1.03 to 1.87) a hemorrhagic stroke, compared to men with a normal BMI (18.5 to 24.9 kg/m2). Conversely, women with lower BMI had a higher risk of having hemorrhagic stroke. With respect to subtypes of hemorrahagic stroke, we observed about a three-fold increase in the risk of intracerebral hemorrhage (ICH) in the highly obese group. However, these trends were not significant in patients with subarachnoid hemorrhages. CONCLUSIONS: Obesity was identified as one of the risk factors in hemorrhagic stroke, in particular ICH. Conversely, in women, a lean body weight increases the risk of hemorrhagic stroke. Consequently, managing one\s weight is essential to reduce the risks of hemorrhagic stroke.
*Body Mass Index ; Case-Control Studies ; Comorbidity ; Female ; Health Behavior ; Humans ; Intracranial Hemorrhages/epidemiology/*etiology ; Korea/epidemiology ; Logistic Models ; Male ; Middle Aged ; Obesity/*complications ; Risk Factors ; Socioeconomic Factors ; Stroke/epidemiology/*etiology

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. The clinical presentation can be similar to that of primary adrenal insufficiency, but most of them may be nonspecific. A female patient of 25 months of age, complainig short stature, showed hypocortisolemia without ACTH & cortisol stimulation by insulin-induced hypoglycemia test. All the other hormone state was normal. Left hand AP view revealed delayed bone age(3 month) compared with chronological age. No radiologic abnormality was found in sella MRI and adrenal CT. Here we report a case of isolated ACTH deficiency presented by short stature.
Addison Disease ; Adrenocorticotropic Hormone ; Female ; Hand ; Humans ; Hydrocortisone ; Hypoglycemia ; Magnetic Resonance Imaging

OBJECTIVE: The aim of this study is to assess the correlation of progesterone challenge test (PCT) and endometrial thickness as a primary screening test for endometrial pathology in postmenopausal women prior to hormonal replacement therapy (HRT). METHODS: 92 postmenopausal women were measured serum estradiol (E2) level, endometrial thickness by transvaginal ultrasonography, and followed by PCT before HRT. And we compared the results of PCT with endometrial thickness and E2 levels. RESULTS: Women with a positive result of PCT in 32% of case and 75.9% of positive test showed endometrial thickness 4 mm or more. However 60.3% of negative test showed endometrial thickness 4 mm or more. This resulted in a PPV=76%, NPV=40%, sensitivity=37%, and specificity=78%. Mean serum E2 was significantly higher in patient with positive PCT but serum E2 showed no positive correlation with endometrial thichness (CI 95%, P Biopsy ; Estradiol ; Female ; Humans ; Mass Screening ; Menopause ; Pathology ; Progesterone* ; Ultrasonography

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly due to M llerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An accurate and prompt diagnosis is of importance to permit treatment and to assure the future fertility of the patient. The simple and adequate treatment of the condition is incision of the obstructed vaginal septum providing adequate drainage of the retained blood. We report a case of uterus didelphys with obstructed hemivagina with brief review of the literature.
Diagnosis ; Drainage ; Dysmenorrhea ; Female ; Fertility ; Humans ; Menarche ; Pelvic Pain ; Uterus*

Maternal and child health is an important issue throughout the world. Given their impact on maternal and child health, nutritional issues need to be carefully addressed. Accordingly, the effect of maternal, child, and nutritional disorders on disability-adjusted life years (DALYs) should be calculated. The present study used DALYs to estimate the burden of disease of maternal, neonatal, and nutritional disorders in the Korean population in 2012. For this purpose, we used claim data of the Korean National Health Insurance Service, DisMod II, and death data of the Statistics Korea and adhered to incidence-based DALY estimation methodology. The total DALYs per 100,000 population were 376 in maternal disorders, 64 in neonatal disorders, and 58 in nutritional deficiencies. The leading causes of DALYs were abortion in maternal disorders, preterm birth complications in neonatal disorders, and iron-deficiency anemia in nutritional deficiencies. Our findings shed light on the considerable burden of maternal, neonatal, and nutritional conditions, emphasizing the need for health care policies that can reduce morbidity and mortality.
Anemia, Iron-Deficiency ; Child ; Child Health ; Delivery of Health Care ; Humans ; Korea* ; Malnutrition ; Mortality ; National Health Programs ; Nutrition Disorders* ; Premature Birth