STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

OBJECTIVE: To assess the umbilical nucleated red blood cell counts and perinatal outcomes according to umbilical artery Doppler end diastolic velocity in severe preeclampsia. MATERIALS AND METHODS: A prospective case-control study comparing 42 severe preeclampsia patients who had present umbilical artery end diastolic velocity with 7 severe preeclampsia patients who absent end diastolic velocity for umbilical nucleated red blood cell counts and perinatal outcomes. RESULTS: Those with absent end diastolic velocity did not have significantly greater nucleated red blood cell counts, but they had increased hemoglobin, hematocrit. These newborn had significantly lower birth weight, increased Cesarean section rate for fetal distress and been more frequently admitted to the neonatal intensive care unit. These newborn also had significantly increased intracranial hemorrhage,assisted ventilation and longer hospital days. CONCLUSION: No correlation with nucleated red blood cell counts and chronic fetal hypoxia were presented. However further study with more expanded cases for the role of nucleated red blood cell counts as a marker of fetal hypoxia will be needed.
Birth Weight ; Case-Control Studies ; Cesarean Section ; Erythrocyte Count* ; Erythrocytes* ; Female ; Fetal Distress ; Fetal Hypoxia ; Hematocrit ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Pre-Eclampsia* ; Pregnancy ; Prospective Studies ; Umbilical Arteries ; Ventilation

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (p<0.001), gestational diabetes 3.7% vs 12.5% (p=0.233), steroid usage 67.0% vs 12.5% (p=0.002), and median TDx-FLM level 59.2 mg/g (range 13.8 - 120.4 mg/g) vs 13.1 mg/g (range 1.20-27.9 mg/g) (p=0.004). The best cutoff point to calculate predictive value for a mature result was >or=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.
Birth Weight ; Diabetes, Gestational ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Lung* ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnant Women ; Rupture ; Sensitivity and Specificity ; Steroids

OBJECTIVE: Our purpose is to determine the optimal cutoff value for the TDx-FLM assay for predicting fetal lung maturity and its clinical efficiency. METHODS: We reviewed records of 81 pregnant women (117 fetuses), who had TDx-FLM assay performed from 1996 through 2000 at Ajou University Hospital. All were delivered between 28 and 37 weeks' gestation. Women treated with steroids after fetal lung maturity test were excluded in this study. In neonatal respiratory outcomes, result of fetal lung maturity was defined as neonates who were not affected by respiratory distress syndrome (RDS). All neonates were divided into mature and immature group according to their respiratory outcomes and clinical characteristics of both groups were evaluated. The predictive values for maturity and immaturity were calculated as previously defined. RESULTS: Among 117 newborns, RDS developed in 8 cases (immature group), and 109 cases were unaffected (mature group). In mature and immature group, mean gestational age was 35.0 weeks and 33.1 weeks (p=0.038), mean fetal birth weight 2313.4 gm and 2036.3 gm respectively (p=0.279). Preterm deliveries were due to preterm labor (32.1% vs 25.0%, p=0.676), premature rupture of membranes (11.9% vs 12.5% p=0.962), preeclamsia (17.4% vs 37.5%, p=0.384), intrauterine growth restriction (11.0% vs 0%, p=0.211), discordant twin (16.5% vs 0%, p=0.212) and other maternal complications (35.8% vs 37.5%, p=0.922) And also, frequencies of twin were 0% vs 64.2% (p<0.001), gestational diabetes 3.7% vs 12.5% (p=0.233), steroid usage 67.0% vs 12.5% (p=0.002), and median TDx-FLM level 59.2 mg/g (range 13.8 - 120.4 mg/g) vs 13.1 mg/g (range 1.20-27.9 mg/g) (p=0.004). The best cutoff point to calculate predictive value for a mature result was >or=24.7 mg/g which gave a sensitivity 93.6%, specificity 87.5%, positive predictive value (PPV) 99.0%, negative predictive value (NPV) 50.0% and efficiency 93.1. CONCLUSION: The best cutoff value of TDx-FLM levels for assessment of fetal lung maturation was 24.7 mg/g in our study group.
Birth Weight ; Diabetes, Gestational ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Lung* ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnant Women ; Rupture ; Sensitivity and Specificity ; Steroids

OBJECTIVE: To compare the obstetrical and perinatal outcomes of twin pregnancies after IVF-ET with those of twin pregnancies conceived spontaneously. METHODS: Two hundred and six cases of IVF-ET twin pregnancies (IVF group) were compared with 229 spontaneously conceived or ovulation induced twin pregnancies (spontaneously conceived group) for obstetrical and perinatal outcomes. All were delivered between July 1994 and February 2002 at Ajou University Hospital. Their clinical records were reviwed. RESULTS: The mean maternal age of IVF group and spontaneously conceived group was 30.7+/-3.7 years, 28.4+/-4.0 years and primiparous women were 86.9%, 58.5% (p=0.000). In IVF group and spontaneously conceived group, mean gestational age was 35.0+/-1.7 weeks, 35.5+/-2.1 weeks (P=0.000), mean birth weight 2311.4+/-411.7 gm, 2324.3+/-447.1 gm (P=0.015), and frequency of birth weight less than 2500 gm 70.6%, 60.3% (p=0.001). In both groups, the frequencies for preterm labor, preeclampsia, intrauterine growth restriction, and birth weight discordancy were 42.2%, 32.3% (p=0.032), 8.3%, 18.3% (p=0.002), 5.3%, 8.7% (p=0.052%), 7.8%, 10.9% (p=0.262), respectively. On the comparison of the chorionicity, monochorion- diamnion was 2.0%, 36.3% (p=0.000) and dichorion-diamnion was 98.0%, 62.8% (p=0.000). And there was no significant difference in congenital anomaly, Apgar scores, frequency and duration of neonatal intensive care unit admission. CONCLUSION: In IVF-ET twin group compared with spontaneously conceived group, there was higher incidence of preterm labor, and low birth weight.
Birth Weight ; Chorion ; Female ; Fertilization in Vitro* ; Gestational Age ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Maternal Age ; Obstetric Labor, Premature ; Ovulation ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin*

OBJECTIVE: To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. METHODS: We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. RESULTS: There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7+/-1.5 vs 38.5+/-1.5 weeks), birth weight (3189.2+/-420.9 vs 3236.7+/-423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. CONCLUSION: We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes.
Birth Weight ; Blood Glucose ; Body Mass Index ; Cephalopelvic Disproportion ; Dystocia ; Female ; Fetal Distress ; Gestational Age ; Glucose ; Glucose Tolerance Test* ; Humans ; Hyperbilirubinemia ; Hypoglycemia ; Infant, Newborn ; Intensive Care, Neonatal ; Oligohydramnios ; Parturition ; Perinatal Mortality ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies

OBJECTIVE: Survivin is a novel inhibitor of apoptosis. Suppression of apoptosis is important for carcinogenesis and tumor growth. The purpose of this study was to investigate whether survivin is expressed in the tissues of normal uterine cervix, cervical intraepithelial neoplasia grade III (CIN III) and squamous cell carsinoma of the uterine cervix, as a first step for evaluation of the clinical significance of survivin in uterine cervical cancer. METHODS: We investigated the expression of survivin in the tissues of 11 cases of normal uterine cervix and 14 cases of CIN III and 20 cases of uterine cervical cancer, using Immunohistochemistry at department of obstetrics and gynecology of Ajou university hospital from Jan. 2000 to Jan. 2001 and then compared with the results of three groups. RESULTS: The expression of survivin is increased significantly in cases of CIN III and uterine cervical cancer compared with controls. (p<0.05, One way ANOVA test) CONCLUSION: This study shows survivin could play an important role in the carcinogenesis mechanism of uterine cervix. And further study will be followed to evaluate the clinical relationship of survivin in uterine cervical cancer and whether to act a prognostic factor or not.
Apoptosis ; Carcinogenesis ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Gynecology ; Immunohistochemistry ; Obstetrics ; Uterine Cervical Neoplasms

No abstract available.
Ascites* ; Intussusception*

OBJECTIVE: To evaluate the effectiveness of hysteroscopy and the incidence of endometrial polyps in women with endometriosis. METHODS: A total of 99 patients determined to be with infertility by laparoscopic procedure from March 1999 to February 2000 were prospectively analyzed at Ajou University Hospital, Suwon, Korea. The study group was 63 patients with endometriosis and the control group consisted of 36 patients without endometriosis. The presence of endometriosis was documented laparoscopically and scored according to The American Fertility Society Classification. We confirmed the presence of endometrial polyps by pathologic examination after polypectomy. We compared the results of the operation to that of the hysterosalpingogram(HSG) and transvaginal sonogram(TVS) before the procedure. RESULTS: Among the 99 patients with infertility, endometrial polyps were found in 40 of 63 women(63.5%) with endometriosis but in only 10 of 36 women(38.5%) without endometriosis. The greater the degree of endometriosis was accompanied by increased incidence of endometrial polyps, and in particular, women with stage three endomeriosis or higher all showed the presence of endometrial polyps. The sensitivity and specificity of the HSG detecting the presence of an endometrial polyp is 55.3%, 87.2%, and that of the TVS is 78.9%, 95.7%. DISCUSSION: The presence of endometrial polyps is significantly associated with the presence of endometriosis, and therefore hysteroscopy should be performed in patients with endometriosis who have not been confirmed with endometrial pathology by HSG or TVS.
Classification ; Endometriosis* ; Female ; Fertility ; Gyeonggi-do ; Humans ; Hysteroscopy* ; Incidence ; Infertility ; Korea ; Laparoscopy ; Pathology ; Polyps* ; Prospective Studies ; Sensitivity and Specificity

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.
Abdominal Pain ; Adult ; Amenorrhea ; Cervix Uteri ; Choriocarcinoma* ; Chorionic Villi ; Diagnosis ; Drug Therapy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans ; Methotrexate ; Neoplasm Metastasis ; Ovary ; Pregnancy ; Pregnancy Tests ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Rupture ; Salpingectomy ; Teratoma ; Uterine Hemorrhage ; Vagina