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: 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 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: 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: To evaluate the perinatal outcomes of twin pregnancies with birth weight discordancy and to determine factors affecting on the outcomes. METHODS: We studied 367 pairs of twin delivered after 28 weeks of gestation at the Ajou University Hospital between June 1994 and June 2000. Twins were stratified into three groups according to the percent difference of birth weight. Birth weight difference less than 15%(concordant) was classified into control group(268 pairs), between 15% and 25% into group 1(72 pairs), and more than 25% into group 2(27 pairs). Perinatal outcomes of each group were assessed retrospectively. RESULTS: In smaller twins, mean birth weight(control vs group 1 vs. group 2 : 2274.3+/-424.9 gm vs. 2012.9+/-303.2 gm vs. 1635.2+/-440.8 gm, p<0.05), duration of neonatal intensive care unit admission(7.6+/-11.5 days vs. 11.6+/-10.8 days vs. 18.6+/-14.4 days, p<0.05), and the frequency of neonatal jaundice(8.6% vs. 12.5% vs. 29.6%, p<0.05), the frequency of small for gestational age infant(8.2% vs. 40.3% vs. 74.1%, p<0.05), and perinatal mortality(2.6% vs. 2.8% vs. 11.1%, p<0.05) in group 2 showed statistically significant difference from control group. No difference was found in larger twins. In multiple logistic regression analysis, independent prognostic factors of discordant twin were gestational age and birth weight. CONCLUSIONS: In twin pregnancies with birth weight discordancy, larger twins showed no difference in perinatal outcomes but smaller twins with birth weight discordancy more than 25% showed significantly higher perinatal mortality and morbidity. However independent prognostic factor was not discordancy itself but gestational age and birth weight.
Birth Weight* ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Parturition* ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin* ; Retrospective Studies ; Twins*

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

No abstract available.
Ascites* ; Intussusception*

OBJECTIVE: The Bethesda System (1991) recommended that the diagnosis of atypical squamous cells of undetermined significance (ASCUS) be qualified when possible to indicate whether a reactive process, or premalignant/malignant process, is favored. In order to evaluate the clinical significance of the qualification, we reviewed our hospital's experience with cervicovaginal smears diagnosed as ASCUS. METHOD: A retrospective study from June 1994 to December 2000 was performed on all cervicovaginal smears with the diagnosis of ASCUS. 3759 cases were included in study group. The 1200 cases of 3759 were not followed up. Histopathologic diagnosis and cervicovaginal smear results were reviewed and compared according to the qualification of ASCUS. The Chi-square test was used. RESULTS: Histopathologic diagnosis of low-grade squamous intraepithelial lesion (LGSIL) was seen in 46.1%, 47.8%, and 44.3% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. Histopathologic diagnosis of high-grade squamous intraepithelial lesion (HGSIL) was seen in 6.0%, 17.2% and 7.8% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. In ASCUS FR group, 1 invasive carcinoma was detected. In ASCUS FD group, 6 carcinoma in situ (CIS), 2 microinvasive carcinoma, 1 invasive carcinoma and 1 adenosquamous cell carcinoma were detected. In ASCUS NOS group, there were 20 CIS, 5 microinvasive carcinoma, 7 invasive carcinoma and 2 invasive adenocarcinoma. The ASCUS FD group demonstrated significant risk for SIL and more severe lesion but ASCUS FR and ASCUS NOS demonstrated no significant difference. CONCLUSION: ASCUS FD group has increased risk for detection of SIL or more severe lesion than ASCUS FR or ASCUS NOS group. But there were also significant number of SIL and even invasive cancer in ASCUS FR and ASCUS NOS group, so qualification of ASCUS was not useful for management and colposcopy-directed biopsy is advocated even in ASCUS FR group.
Adenocarcinoma ; Biopsy ; Carcinoma in Situ ; Diagnosis ; Retrospective Studies