OBJECTIVES: To predict of the survival of patients with epithelial ovarian cancer, multivariable analysis was done to identify variables with independent prognostic factors. Based on materials from 191 clinical trials performed by Department of Obstetrics and Gynecology, Hanyang University Hospital, we constructed a prognostic index (Pp with considerable predictive power for long-term survival of patients with epithelial ovatian cancer treated with cis-platin based combination chemotherapy, METHODS: On identifying variables with independent prognostic value, statistical analysis were performed with clinicopathologic variables including age, FIGO stage, histologic subtype, histologic grade, residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor markers(CA 125, CA 19-9). We also analyzed biological variables using immunohistochemical staining for GST-pie (glutathione-s-transferase-pie), p-glycoprotein, and MT (metallothinein) as a drug resistance and uPA (urokinase type plasminogen activator), PAI-1 (plasminogen activator inhibitor-l), nm23 (nonmetastatic gene 23) as a tumor invasion and metastasis. In addition, univariable analysis was performed followed by multivariable analysis using Coxs proportional hazards model to identify variables predictive of poor prognosis. Prognostic index (PI) was calculated based on sum of individual beta-coefficient of the most important independent prognostic value. RESULTS: With univariable analysis, age, FIGO stage, histologic grade, histologic subtype, presence of ascites, residual tumor, initial value of CA 125, MT, uPA, and PAI-1 were found to predict of patients survival. In the multivariable analysis and proportional hazard model, the pretreatment characteristics needed for the calculation of the PI are the age, the site of metastases expressed as stage, the histologic subtype, the size of residual tumor, the histological grade, and the presence of ascites. In the subgroup comprising the 10% of the patients with the best prognosis, 5-year survival rate was 78.9%, whereas in the subgmup comprising the 10% with the poorest prognosis, 5-year survival rate was 7.1%, which illustrates the large variability of the prognosis among patients. CONCLUSIONS: The PI was found to retain its value after response was achieved. The information provided by the PI can be expected to be useful in treatment planning and the proper stratification of patients in clinical trials.
Ascites ; Blood Platelets ; Drug Resistance ; Drug Therapy, Combination ; Gynecology ; Humans ; Neoplasm Metastasis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms* ; P-Glycoprotein ; Plasminogen ; Plasminogen Activator Inhibitor 1 ; Prognosis ; Proportional Hazards Models ; Survival Rate

OBJECTIVES: This retrospective study was conducted to analyze the hypothesis that with neoadjuvant chemotherapy of vinblastine, bleomycin, and cisplatin followed by radical hysterectomy or radiation therapy and concurrent chemoradiation with cisplatin based regimen would improve survival in patients with barrel-shaped or bulky-endophytic (Diameter > 4cm) cervical carcinomas than those of radiation alone or combined radiation and surgery. STUDY DESIGN: Eighty-eight patients with barrel-shaped or bulky-endophytic cervical carcinomas, treated at the Hanyang University Hospital from 1983 to 1997, were the subjects of this investigation. Fifty-six of these patients were treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy ( Stage I b2, 8; IIa, 15; IIb, 20; III- IV, 13), twelve patients were treated by neoadjuvant chemotherapy followed by radiation therapy ( Stage Ilb, 4; IIJ-IV, 8), and twenty patients were treated by concurrent chemo-radiotherapy ( Stage IIb, 2; III-IV, 18). RESULTS: The incidence of parametrial extension and pelvic lymphnode metastases was higher in patients with barrel-shaped or bulky-endophytic cervical carcinomas than non-barrel-shaped cervix (p .025: .001). 5-years disease free survival rate was determined for patients treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy was 73.3 %. For patients treated by neoadjuvant chemotherapy followed by radiation therapy it was 45.7%. For patients treated by concurrent chemo-radiotherapy it was 46.1%. CONCLUSION: These data support an improvement in survival of patients with barrel-shaped or bulky-endophytic cervical carcinomas treated by neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy and concurrent chemo-radiotherapy.
Bleomycin ; Cervix Uteri* ; Cisplatin ; Disease-Free Survival ; Drug Therapy* ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Node Excision ; Neoplasm Metastasis ; Retrospective Studies ; Vinblastine

BACKGROUND: Carcinoma of the uterine cervix is a theoretically preventable disease because its precursor lesions can be detected by cervical Papanicolau smears and appropriately treated, Although cervical cytology screening programmes have resulted in the redution of cervical cancer incidence and mortality, Pap smear have been subjected to intense scrutiny and criticism in recent years. The focus of criticism has been the false-negative Pap smear, and the false-negative Pap smear is the major quality issue currently facing the physicians. To reduce the false-negative rate of Pap smear, it is essential to improve the accuracy of Pap smear. But false-negative rate of Pap smear has been reported variously. OBJECTIVE: This study was undertaken to evaluate accuracy of Pap smear by study false-negative and false-positive rate of Pap smear and to determine whether false-negative and false-positive rate had any correlations with clinical factors. STUDY DESIGN: The study population was comprised of 346 women, who were undertaken gynecologic operation at the Department of Obstetrics & Gynecology at Hanyang University hospital between March, 1997 and April, 1998. All patients were taken Pap smear before operation. In 93 women of these, preoperative diagnosis were cervical intraepithelial neoplasia and carcinoma in situ of uterine cervix, and in 253 women of these, preoperative diagnosis were benign disease as uterine myoma or adenomyosis, etc. All of their surgical specimen were examined. Pap smear, pathology, medical charts of all patients were reviewed retrospectively, and false-negative rate and false-positive rate were calculated. Clinical factors that associated with false-negative and false-positive rate were evaluated. Fishers exact test and Pearson chi-square test were used of statistical analysis, RESULTS: False-negative rate of Pap smear was 7.2%, false-positive rate was 4.6%, corresponding rate with histology was 88.2%. Sensitivity and specificity of PAP smear were 87.0% and 97.0% respctively. According to gross finding of uterine cervix, erosion was 46.6% in cervical intraepithelial neoplasia, 67.8% in carcinoma in situ, 66.6% in microinvasive carcinoma of uterine cervix and 55.3% of 103 erosion findings was cervical intraepithelial neoplasia, carcinoma in situ or microinvasive carcinoma. 23.1% of cervical lesion were normal gross finding. Menopause was associated with false-negative rate and previous vaginal infection history, previous cervical minor operation, delivery mode, contraception method, pelvic inflammatory disease history, vaginal bleeding at Pap smear and gross finding of cerbix were not associated. There were no clinical factors that were associated with false-positive rate. CONCLUSION: Compared with other reports, false-negative rate(7.2%) and false-positive rate(4.6%) of Pap smear was lower and corresponding rate(88.2%) was higher in Hanyand university hospital. Because of higher false-negative rate in menopausal women, it need more careful to take and interpretate Pap smear in these group.
Adenomyosis ; Carcinoma in Situ ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Contraception ; Diagnosis ; Female ; Gynecology ; Humans ; Incidence ; Leiomyoma ; Mass Screening ; Menopause ; Mortality ; Obstetrics ; Pathology ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

Twenty six cases of borderline ovarian tumor(BOT) were treated between Jan. 1985 and Dec. 1997 at the Department of Obstetrics and Gynecology, Hanyang University. The clinical records were reviewed for all patients including histopathology, clinical features, and follow-up. The frequency of BOT was 12%(26/214) of epithelial ovarian malignancies, and patients with these tumors tend to present at a younger age(36 yrs) than those with invasive carcinomas. In terms of histologic type, mucinous type(21/26: 81%) were more prevalent than serous tumor(5/21: 19%) in this study. The positive rate of CA 125 was 20% in serous, and the positive rate of CA 19-9 was 24% in mucinous tumor. The size of mucinous was larger than that of serous tumors(17.1 cm vs 9,3 cm). Almost all of these tumor categorized as early stage(stage I: 96%), however, only one patient with serous tumor had advanced stage of disease(stage III: 4%), Therefore BOT tend to be diagnosed as earlier than invasive carcinoma. About 2/3 of patients were treated as conservative surgery(unilateral salpingooophorectomy or enuclation). Postoperative adjuvant chemotherapy was not given about half of cases(13/26). Median follow-up was 43 months and recurrent case was found only one in serous tumor, All patients in this study are still alive and free of disease except one, 5-year survival rate was 100%. But large number of study and long-term follow-up are needed to make a decision to treat and manage of BOT.
Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Mucins ; Obstetrics ; Ovary* ; Survival Rate

OBJECTIVE: The purpose of this study was to analyze the clinical characteristics and prognosis of small cell uterine cervical carcinoma with neuroendocrine differentiation. METHODS: Patient's medical records were reviewed retrospectively who were diagnosed as small cell carcinoma of uterine cervix and were treated at Hanyang University Hospital between 1972 and 1997. RESULTS: Between 1972 and 1997, of 1164 patients who were diagnosed as invasive cervical cancer, there were 10 cases of small cell carcinoma of uterine cervix in the department of obstetrics and gynecology, Hanyang University Hospital. The incidence of small cell carcinoma in invasive cervical cancer was 0.9% (10/1164). Of 10 small cell carcinoma, seven(70%) were neuroendocrine types which were identified with several kinds of immunohistochemical stains (Chromogranin, Grimelius, and/or NSE). The age of these 7 patients ranged from 34 to 63 years (mean 49). Two were in stage Ib, 3 in stage lla, I in stage IIIb, and 1 in stage IVb. Patients with stage Ib-IIb (n 5) received 3-5 courses of neoadjuvant VBP chemotherapy (vinblastine, bleomycin and cis-platinum) followed by radical hysterectomy with pelvic and paraaortic node dissection. One IIIb patient was managed with concurrent chemo-radiation(3 cycles of cis-platinum & 5-FU) followed by 6 courses of chemotherapy. One IVb patient was treated by palliative chemotherapy with 8 cycles of VBP chemotherapy. Of 5 paticn(s who underwent surgery, none showed pelvic lymph node metastases. These 7 patients were folk>wed for 8 - 62 months (average: 20 months). During this period, 5 patients died of disease hetween 8 and 62 months later and 2 patients are still alive for 12 (stage Ib) and 26 months (stage Ib), respectively. In the contrary, of 3 patients without neuroendocrine differentiation, who underwent neoadjuvant VBP chemotherapy followed by radical hysterctomy with pelvic and paraaortic node dissetion or concurrent chemo-radiation, two stage IIb patients are still alive for 58 and 74 months, and one IIIb patient died of disease 12 months later. CONCLUSION: In summary, neuroendocrine differentiation seemed to adversely affect the prognosis and longterm survival of small cell carcinoma of uterine cervix. So, for this high risk group, more aggressive therapy would be need to improve outcome. However, as the number of patients were small in our study, further study with large number of patients are warranted.
Bleomycin ; Carcinoma, Neuroendocrine* ; Carcinoma, Small Cell ; Cervix Uteri* ; Cisplatin ; Coloring Agents ; Drug Therapy ; Female ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Obstetrics ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms

OBJECTIVE: Our purpose was to establish whether FHR recording tape and telemetry system at home interpreted by remote telemedicine link is comparable to interpretation at hospital in a high-risk patient population. Patients and METHODS: Twenty women whose pregnancy was suspected as high risk were entered to study. All pregnancies were at term(7 at 38th weeks, 7 at 39th weeks, 6 at 40th weeks). Remote FHR monitoring at hospital was made for consecutive 6 days, using FHR-telemetry system at home which already developed and used by authors from 1991. Patients recorded FHR sound using recording tape for 5 days. On the 5th day, real-time transmitting of FHR sound to the hospital was also done via telephone lines after recording of FHR sound. On the 6th day, FHR test(NST) was performed at hospital. The signal loss(%), baseline FHR(bpm), and FHR variability were compared using computerized FHR analysis system(HYFM-I) after re-play of 5-days recording tapes at hospital with real-time transmitting data and in-hospital FHR test results. RESULTS: The signal loss was highest with real-time transmiting data when comparing with in-hospital FHR analysis. No significant differences were observed among 5-days data of FHR recording tapes. CONCLUSIONS: Frequent antenatal visit of high-risk pregnancy patients were in diHuities of their pregnancy outcomes. And many rural areas of our country are without adequate access to basic maternity services. From this point of view, a fetal telemedicine service is needed, and in fact, technically and clinically feasible. Our demonstration suggests that such a service reduces the need for hospital visit of high risk pregnancy women. Further evaluation in a variety of clinical settings is now indicated, along with cost-benefit analysis.
Cost-Benefit Analysis ; Female ; Fetal Heart* ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, High-Risk ; Telemedicine ; Telemetry ; Telephone

The factor VIII gene comprises 26 exons spanning 185kb of DNA located at the distal end of the long arm of the X-chromosome, Defects in this gene cause hemophilia A, a bleeding disorder affecting 1/10,000 males. Linkage analysis is known as an efective method for the prenatal diagnosis and for the identification of carrier status. Several polymorphic markers had been studied to establish the diagnostic procedure for hemophilia A in Korea, and heterozygosity of 96% could be expected with 4 markers such as St14.1/Taq I, intron 18/Bcl I, intron 22/Xba I and DX13/Bal II. But in some families, above markers were not informative, and it was required another polymorphic markers should be applied for the diagnosis. Two recently identified microsatellite polymorphisms in intron 13 and intron 22 of FVIII gene were investigated to increase the heterozygosity and to diagnose previously uninformative families. Intron 13(CA)n repeats polymorphism showed 7 alleles with expected heterozygosity of 0.5336. Intron 22(CA)n(TC)n repeats polymorphism showed 4 alleles with expected heterozygosity of 0.5146. With the two microsatellite polymorphisms we could expect the heterozygosity of 0.6756. And we could successfully perform prenatal diagnosis previously uninformative family with intron 13 microsatellite polymorphism. With 4 polymorphisms detected by polymerase chain rection(intron 13 and intron 22 microsatellite polymorphisms, intron 18/Bcl I and St14.1 VNTR/Taq I), about 97% of hemophilia A family in Korea would be diagnosed by linkage analysis.
Alleles ; Arm ; Diagnosis ; DNA ; Exons ; Factor VIII* ; Hemophilia A ; Hemorrhage ; Humans ; Introns* ; Korea ; Male ; Microsatellite Repeats* ; Prenatal Diagnosis

OBJECTIVES: This study have demonstrated that transforming growth factor TGF-beta s(TGF-beta 1 and TGF beta 2) may play an important role in implantation and also to determinethe defferences of in the decidua and placenta between normal pregnancy, ectopic pregnancy, and missedabortion. METHODS: We have studied the expression of TGF-beta 1 and TGF-beta 2 byimmunohistochemical staining method in the decidua trophoblasts of normal early pregnancy, ectopicpregnancy, and missed abortion. RESULTS: In the epithelial cells and decidua, TFG-beta 1 was moderately expressed in thenormal pregnancy and weakly expressed in the ectopic pregnancy. But TGF-beta 1 was notexpressed in missed abortion. In contrast, the epithelial expression of TGF-beta 2 was moderatelyin all groups and there are no differences among the groups. And in the decidua, TFG-beta 2 wasmoderately expressed in the normal pregnancy and missed abortion and was weakly expressed in theectopic pregnancy. In the trophoblasts, TFG-beta 1 was weakly expressed in all groups andTGF-beta 2 was moderately expressed in all groups that are no differences among the groups. CONCLUSIONS: These findings suggest that TGF-beta 2 may have an important role in deciduaduring pregnancy, especially normal pregnancy. These could indicate that the presence oftroplablast and/or hormonal milieu of normal pregnancy resulted in the expression of TGF-beta s,particularly TGF-beta 1.
Abortion, Missed* ; Decidua ; Epithelial Cells ; Female ; Placenta ; Pregnancy* ; Pregnancy, Ectopic ; Transforming Growth Factor beta ; Transforming Growth Factors ; Trophoblasts

OBJECTIVE: Transabdominal cervico-isthmic cerclage(TCIC) may increase the fetal salvage rate and pregnancy outcome in selected women when poor obstetric outcome is related to previously failed transvaginal cervical cerclage and an anatomically defective cervix. Our purpose was to evaluate the outcomes after transabdominal cervicoisthmic cerclage during pregnancy. STUDY DESIGN: A retrospective review was done from patients who had been received transabdominal cervicoisthmic cerclage during pregnancy at Hanyang University Medical Center from October, 1989 to April 1997. The fetal salvage rate before and after post-conceptional transabdominal cervicoisthmic cerclage were compared and analysed. RESULTS: The seventy-eight patients had 95 successful pregnancies out of a total of 97. Thus the fetal salvage rate of TCIC during in pregnancy was 97.9 %. Of 78 patients, nineteen patients had the second succesful pregnancies and repeat cesarean deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage during pregnancy offers a high fetal salvage rate with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.
Academic Medical Centers ; Cerclage, Cervical ; Cervix Uteri ; Female ; Humans ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Retrospective Studies ; Uterine Cervical Incompetence

Previous studies have shown that the cancer cell lines secrete multiple cytokines, such as macrophage colony-stimulating factor(M-CSF), granulocyte-macrophage colony stimulating factor(GM-CSF), interleukin-l(IL-1), interleukin-2(IL-2), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-alpha). We evaluated the levels of IL-2, IL-6, and TNF-alpha in the ascites of 23 patients with ovarian cancer. These levels were then compared with cytokine concentration found in 10 patients who had benign ascites and also studied the relation between levels of cytokines and clinical parameters. Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of cytokines in ascitic fluids. The median age of the group was 56, and the median follow-up time was 24 months. The levels of IL-2 was not elevated in ascites of ovarian cancer(30.5 vs 37.2 pg/ml, p=0.083), 1 he levels of TNF-alpha in the ascites with ovarian cancer were higher when compared with ascites of benign disease and was nearly approached statistically significant(91.0+/-20.7 vs 440.2+/-117.9pg/ml, p=0.058). Significantly higher IL-6 levels were detected in patients ascites compared with ascites with benign disease(354.3+/-42.9 vs 5,605+/-1,137pg/ml, p=0.006). IL-6 and TNF-a levels in ascites did not correlate statistically with tumor volume, histologic type or with survival time. IL-6 levels did not correlated statistically with volume of ascites. IL-6 and TNF-a levels did not correlated either. Circulating platelet counts in patients with ovarian cancer were significantly higher than in patients with benign conditions (282.6+/-5 vs 388.4+/-21.2x-10(9)/l, p=0.003). Thrombocytosis(platelet counts>400x10(9)/l) occured in 35%(8/23) of the cases with ovarian cancer. IL-6 levels in ascites correlated signi-ficantly with circulating platelet counts(R=0.427, p=0.042). This study showed that the patients with ovarian cancer have elevated levels of IL-6 in ascites. IL-6 levels were not correlate with disease status in patients with ovarian cancer. However, the correlation was found between IL-6 levels and thrombocytosis. This observation suggest a role for IL-6 in the development of tumor-associated thrombocytosis. A larger study would help in evaluating the potential biological roles and use of cytokines as tumor markers in ovarian cancer.
Ascites* ; Ascitic Fluid ; Blood Platelets ; Cell Line ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-2 ; Interleukin-6 ; Macrophages ; Necrosis* ; Ovarian Neoplasms* ; Platelet Count ; Thrombocytosis ; Tumor Burden ; Biomarkers, Tumor ; Tumor Necrosis Factor-alpha