OBJECTIVE: We tried to determine the relevance of thrombocytosis as a possible prognostic factor in patient with epithelial ovarian cancer. METHODS: One hundred and eighty-three (183) patients with epithelial ovarian cancer had been surgically treated in our hospital between January 1984 and December 2001. Uni- and multivariate analyses were performed of 9 clinical variables including age, FIGO stage, histologic subtype, grade, volume of residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor marker (CA 125). The Kaplan-Meier method and log-rank test were used for univariate analysis and a multiple regression analysis based on the Cox proportional hazards model was done to find the independent prognostic variables. RESULTS: Prevalence of thrombocytosis was 20.8% and significantly correlated with FIGO stage (p=0.015), tumor grade (p=0.029), presence of ascites (p=0.001) and volume of residual tumor (p=0.032). Significant difference in survival between patients with or without thrombocytosis was found (p=0.006). Multivariate analysis model was used and only volume of residual tumor (p=0.004) was significant independent prognostic variable. Thrombocytosis (p=0.041) was significant independent prognostic variable in patients with early FIGO stage of disease. CONCLUSION: Thrombocytosis is a useful prognostic factor in epithelial ovarian cancer and significantly independent prognostic factor in patients with early FIGO stage of disease.
Ascites ; Blood Platelets ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Ovarian Neoplasms* ; Prevalence ; Proportional Hazards Models ; Thrombocytosis*

Heterotopic pregnancy is a rare event, occurring less than 1 : 30,000 pregnancies in natural conception cycles. With assisted reproduction techniques, however, this incidence increase to between 1 : 100 and 1 : 500. It is known to present with a variety of symptoms and signs after leading to a delay in establishing the correct diagnosis. Delay in diagnosing and surgery can jeopardize both maternal well-being and survival of the intrauterine fetus. Prompt diagnosis and appropriate surgery contribute to the favorable outcome for the mother and surviving infant. We experienced a case of heterotopic pregnancy after in vitro fertilization and embryo transfer, which carried the intrauterine pregnancy to term delivery following rupture of the tubal pregnancy, with hypovolemic shock. So we report this case with review of literatures.
Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Fetus ; Humans ; Incidence ; Infant ; Mothers ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Reproductive Techniques ; Rupture ; Shock

OBJECTIVE: To evaluate pathological complete remission rate (pCR), survival rate, recurrence rate, 91 patients who had clinical complete remission with epithelial ovarian cancer were studied. METHODS: From 1983 to 2002, 91 consecutive patients with epithelial ovarian cancer underwent surgical cytoreduction followed by platinum-based chemotherapy at the Department of Obstetrics and Gynecology, Hanyang University Hospital. At the conclusion of chemotherapy, all patients who were clinically disease free and whose CA 125 was < 35 were offered a second-look operation that obtained over 20 specimens. Of 91 patients who qualified for second-look, 57 underwent the procedure and 34 did not undergo the laparotomy. RESULTS: Among 57 patients who had been performed second-look laparotomy, 40 patients (70%) had negative pathology, 9 (16%) were microscopically positive, and 8 (14%) had gross disease. Patients with positive findings received individualized salvage therapy (14/17). FIGO stage (p<0.01), initial CA 125 level (p=0.07) and residual tumor at primary surgery (p=0.01) correlated with second-look results. Eight (20%: 8/40) of the patients with negative pathology have recurred. Five year survival rate was 95% in patients refusing second look (n=34) was similar to 77% in patients who had been performed second-look operation (n=57). Five-year and ten-year survival rates were 77% and 68% in patients who had performed second-look laparotomy. And 5-year and 10-year survival rates were 84%, 84% in 40 patients with negative pathology, however, 53%, 34% of 17 patients with positive result. Stepwise logistic regression selected two covariates significantly affecting survival: the stage and residual tumor. CONCLUSION: Using the protocol described in a population of optimally resected patients with advanced stage ovarian cancer, second-look laparotomy can impact positively on survival. Patients with residual tumor > 2 cm with advanced stage at primary surgery and negative second-look findings should be the focus of future protocols for consolidation chemotherapy.
Consolidation Chemotherapy ; Drug Therapy ; Gynecology ; Humans ; Laparotomy* ; Logistic Models ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms* ; Pathology ; Recurrence ; Salvage Therapy ; Survival Rate

BACKGROUND: Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 microg), and to identify factors associated with efficacy. METHODS: A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. RESULTS: A total of 370 patients were included in final analysis. The median BMD was 0.81 +/- 0.12 g/cm2 at pre-treatment and 0.84 +/- 0.13 g/cm2 after one year. The average BMD improvement was 3.4% +/- 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. CONCLUSION: Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy.
Abdominal Pain ; Absorptiometry, Photon ; Alendronate ; Bone Density ; Calcitriol ; Calcium ; Compliance ; Drug Combinations ; Female ; Humans ; Osteoporosis ; Osteoporosis, Postmenopausal ; Physicians, Family ; Social Class ; Spine ; Surveys and Questionnaires