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• Study of Nurses' Knowledge and Attitudes on Hormone Replacement Therapy
  Eon-Na Ryoo, Kyung-Sook Park, Hyoung-Moo Park
  The Journal of Korean Society of Menopause.2012; 18(1): 43.     CrossRef

We have studied infertility rate and what factors influence the infertility rate in the effort to lower infertility rate after the microsurgical reversal of tubal sterilization.

Two-hundred and seventy-three microsurgical reanastomosis were performed during 6 years between January 1989 and December 1995. Follow-up of postoperative outcomes of 172 patients were identified.

The infertility rate after microsurgical tubal reanastomosis was 24.4%. Mean age of infertile group was 34.2 years old. The infertility rate according to previous sterilization type was 14.3% with ring, 45.2% with cauterization, 7.1% with Pomeroy's method and 33.4% with pelvic adhesion or hydrosalpinx. The infertility rate was higher than pregnancy rate with reconstructive tubal length less than 4cm.

We have concluded that age of patient, the type of previous sterilization, the interval between sterilization and tubal reversal, and the reconstructed tubal length agter reversal were major factors influencing infertility after tubal reversal.

Of all the gynecologic cancers, ovarian malignancies represent the greatest clinical hallenge. Epithelial ovarian cancer are the most common ovarian malignancies and because they are usually asymptomatic until they have metastasized, patients present with advanced disease on morethan ⅔ of the cases.

The author have studied forth-five cases of epithelial ovarian cancers in sixty-one cases ofmalignant ovarian tumors from january 1985 through october, 31, 1995.

The result of this study were summarized as follows:

1) Among 245 cases of the ovarian tumors, malignant ovarian tumors were 61 cases (24.89%)and of which 45 cases (73.8%) were epithelial origins and of which 6 cases (9.8%) were metastatic origins.

2) The prevalent age group of the epithelial ovarian cancer was 4th decade and mean agewas 45.1±17.6 years.

3) The clinical manifestations were palpable abdominal mass, 19 cases (42.4%), lower abdominal discomfort or pain, 15 cases (33.3%), abdominal distension, 11 cases (24.4%), menstrual irregularities, 3 cases (6.7%), weight loss, 1 case (2.2%) and urinary frequancy, 1 case (2.2%).

4) Among 45 cases of epithelial ovarian cancer, mucinous cyst adenocarcinoma 21 cases (46.6%) were the most common and followed by serous cystadenoracinoma 17 cases (37.7%), endometrioid adeno carcinoma 3 cases (6.7%), malignant Brenner tumer 2 cases (4.4%), clear cellcarcinomas 1 case (2.2%), and undifferentiated carcinmas 1 case (2.2%).

5) Mean size of tumors was 14±6.78cm in diameter, bilaterality of the tumors was 22.2%.

6) The most surgical treatment were total abdominal hysterectomy, bilateral salpingoophorectomy, omentectomy and debulking tumors resection 24 cases (53.3%), but unilaterat salpingo-oophorectomy was the freqnent method of surgery 14 cases (31.1%) due to under diagnosis of the tumors and preservation of fertility in cases of no gross malignant lesions.

7) For clinical stages, stage 1 was 23 cases (51.1%), stage II was 4 cases (8.88%), stage III was 7 cases (15.5%) and stage IV was 9 cases (20%).

8) Cytology of the ascites or peritoneal washing revealed that class I and class II were 12cases (57.1%) and more than class IV were 9 cases (42.9%).

Late two-cell mouse embryos from ICR(Swiss albino) mice were cultured to the blastocyst stage in New MHBS media.

In order to invertigate the effect protein macromolecule and glutamine on the development of preimplantation embumin(BSA), polyvinylpyrolidone (PVP) and glutamine and the rate of blastocyst developnent was observed.

The results were as following:

1) There were a signigicant difference in blastocyst development of early and late 2-cell mouse embryos(p<0.05).

2) The development of late 2-cell mouse embryo to blastocyst in the BSA-free but containing glutamine was higher than those of 0.4% BSA, 0.4% PVP group.

3) The development of late 2 cell mouse embryo in the MHBS containing glutamine was higher than MHBS with BSA but glutamine-free media group(p<0.05).

4) Blastocyst development is higher in media supplemented with glutamine than in media containing no glutamine.

5) These study suggests that the addition of glutamine to the culture media may be a required for energy substrate for in-vitro development of late 2-cell mouse embryo.

The postmenopausal state is characterized by an absence of ovulation and a reduction of ovarian estrogen secretion. Postmenopausal women is associated with several symptoms including vasomotor flushes, atrophic vaginitis, osteoporosis and increased risk of cardiovascular disease. Varying doses of estrogenic preparation have been used to treat these symptoms and have displayed changes in plasma lipoprotein level.

We administered different doses of oral conjugated estrogen to 30 postmenopusal women and made comparative analysis of lipoprotein changes by varying doses.

The results were as follows :

1) The changes of plasma estradiol after estrogen replacement therapy in group I and group II were increased by 54.96±11.36 pg/ml(p<0.01) and 68.37±16.91 pg/ml(p<0.01), but the difference of changes between two group was not statistically significant(p>0.05).

2) The changes of plasma FSH after estrogen replacement therapy in group I and group II were decreased by 52.94±12.95 MIU/ml(p<0.O5), and 60.24±8.09 MIU/ml(p<0.01), and difference of changes between two groups was not statistically significant(P>0.05).

3) The changes of plasma cholesterol after estrogen replacement therapy in group I and group II were decreased 17.I±4.28 mg/dl(p<0.01) and 11.07±9.01 mg/dl(p>0.05), and differenee of changes between two groups was not statistically significant(p>0.05).

4) The changes of plasma triglyceride after estrogen replacement therapy in group I andgroup II were decresead by 145.3±20.3 mg/dl(p>0.05) and 35.4±13.87 mg/dl(p>0.O5), but difference of changes between two groups was not statistically significant(p>0.05).

5) The changes of plasma HDL after estrogen replacement therapy in group I and group II were increased by 3.0±3.50 mg/dl(p>0.05) and 11.05±5.30 mg/dl(p<0.05).

6) The change of plasma HDL/cholesterol after estrogen replacement therapy in group I and group II were increased by 5.9±1.33% (p<0.01) and 6.31±2.19% (p<0.05), but difference of changes between two groups was statistically significant(p>0.05).

7) The changes of plasma LDL/cholesterol after estrogen replacement therapy in group I and group II were decreased by 3.01±2.7% (p<0.01) and 7.71±2.13% (p<0.01), but difference of changes between two groups was not statistically significant(p>0.05).

8) The changes of plasma VLD/cholesterol after estrogen replacement therapy in group I and group II were increased by 1.81±2.54% (p>0.05) and 5.30±2.38% (p>0.O5) and difference of changes between two groups was statistically significant(p>0.O5).

9) The changes of plasma HDL/LDL after estrogen replacement therapy in group I andgroup II were increased by 0.21±0.04% (p<0.01) and 0.247±0.06(p<0.01), but difference of changes between two groups was statistically significant(p>0.05).

The changing life pattern for women in current society is after a postponement of childbearing. Thus, the impact of older maternal age on pregnancy outcome becomes increasingly important.

The obstetric outcomes of women 35 years of age older are widely considered to be less favorable than those of younger women.

124 elderly primiparas at Department of Obstetrics and Gynecology. Ewha Womans University Hospital from January. 1980. to December 30. 1990 were studied.

The results were as follows:

1) There were 124 cases of elderly primiparas among total 24,432 deliveries and the incidence of the elderly primipara was 0.4%.

2) 79.8% of elderly primipara was distributed from 35 to 38 years.

3) One parity of pregnannt women over 35 years was 163 cases(31.6%).

4) 109 cases(87.9%) of total cases were vertex presentation and 14 cases(11.2%) were breech and 1 cases(0.8%) was face presentation.

5) As regards antepartum complication, the incidence of hypertensive disorder was 17.7% and PROM was 11.2% respectively.

6) 51 cases(41.1%) were delivered vaginally and 73 cases(58.8%) were delivered abdominally.

7) Among the indication of cesarean section, the highest incidence was elderly primipara (33.1%) and other indications were CPD, breech, placenta previa and fefal distress in order.

8) The perinatal mortality rate was 96.8(9.7%) in elderly primipara and 81.8(8.2%) in elderly multipara.

9) There was no congenital malformation.

10) The mean gestational age was 38⁸weeks and preterm pregnancy(before 36 weeks) was 19 cases(15.3%).

11) The mean birth weight of the infant was 3100gm and premature baby less than 2500gm was 12.1%.

No abstract available.

The accurated prediction and detection of follicular growth is very important in the successful investigation and treatment of the infertility. Recently, serial visualization of the ovarian follicles with ultrasound have been described as rapid, reliable methods for monitoring of follicular growth.

Human ovarian follicular development measured by peripheral plasma estradiol and ovarian follicular growth assessed by serial ultrasonic visualization of the ovary were compared and analyzed in 17 normal ovulatory cycling women.

The results were as follows :

1) The mean follicular diameter was ranged 0.93±0.07-2.07±0.07cm and the maxium diameter of ovarian follicle was 2.07±0.07cm on the day of LH surge. Daily growth rates of ovarian follicle was 1.5-2.3mm/day from the day 4 to 0. There was a correlation between follicular diameter meansurements and peripheral plasma E₂ levels on day -7 to day 0 of 17 normal cycling women. The linear correlation coefficient was r=0.9669(p<0.01).

2) Plasma LH level increased from day-7, 29.9±3.72mIU/ml to day of the LH surge, 108.69±16.9mIU/ml.

3) Plasma progesterone level begin to increase on the day 0. 0.75±0.2ng/ml, on the day+1, 1.08±0.2ng/ml and was reached to levels of 5.65±1.08ng/ml on the day + 3 after ovulation.

4) These study show that ultrasonic measurement of follicular diameter are valuable in the prediction of follicle growth, and ovarian function.

For the aim of clarifying oocyte maturation process in mammalian oocyte, we have studied the patterns of the germinal vesicles breakdown according to the stage of nuclear changes after various periods of culture.

As the culture time was prolonged, the germinal vesicles breakdown were significantly increased and after nine hours of culture, 14% of the oocytes were in metaphase II. After 12 and 16 hours of culture, the germinal vesicles break down occurred 35% and 54% respectively.

The oocytes of metaphase II were significantly accumulated after 9 hours of culture.

Each steps of the meiotic division appeared to be asynchrony in maturation of oocytes in vitro.

We have found that in vitro mouse oocyte can be occurred spontaneous maturation without the gonadotropin stimulation.

A clinical observation has been made on 500 cases of posttern pregnancy out of 6231 cases delivered at the dept of obstetrica and gynecology, collage of medicine, Ewha womens university for the past 3 years fom Jan. 1, 1983 to Dec. 31, 1985. A pregnancy was considered as postterm when exceeds 42 weeks calculated from the first day of the last menstrual period. The result are as follows: 1) The incidence of postterm pregnancy was 8.02%. Among these 500 cases. 412 cases (6.61%) had 42 gestational weeks. 2) Total delivery in ralation to age distribution showed 3724 cases in 25~29 aged group and 1099 cases in 20~24 aged group while the incidence of postdate pregnancy showed 10.0% in 20!24 aged group and 8.62% in 25~29% aged group respectively. 3) The spontaneous onset of labor in posttem pregnancy was noted in 210 cases (42.0%). 4) Total duration of labor over 24 hours showed 1.12% and 0.63% in primipara and multipara and duration of second stage in labor over 2 hours showed 4.09% and 4.43% in primipara and multipara respectively. 5) The incidence of cesarean section was 30.92% in control group and 36.8% in posttem delivery group. 6) The number of newborn infants weighing 3000~3499 gm were 2447 cases (39.27%) in the control group and 207 cases (41.4%0, more higher in the postdate delivery group. 7) The incidence of the meconium stained amniotic fluid was 21.4% and low Apgar score was more common in meconium stained group. 8) The maternal complications were more common in meconium stained group. 9) The perinated death were 35.94 and 34.0 in control and postterm pregnancy repeatively. The incidence of the perinatal mortality by gestational weeks showed 8 cases for 42 weeks.

Assessment to temporal relationship between levels of prolactin, LH, FSH, estradiol and progesterone in 12 ovulatory cycle was made. The serum prolactin concentrations were measured in daily blood samples by a double antibody radioimmunoassay methods. Thero was a tendency of increase in serum prolactin level during the late follicular phase, however no significant difference was found between the follicular and luteal phase(15.73±0.88ng/ml vs 12.93±0.37ng/ml). No correlation was found between levels of prolactin and, those of LH, FSH, estradiol and progesterone. The mean serum prolactin level during the normal ovulatory cycle was 14.3±0.47ng/ml(S.E). The data showed that the highest mean prolactin concentration was found on the day of +8 and +14 with second peak of estradiol and variation of episodic fluctuation or erratic spikes in the normal ovulatory menstrual cycle. These findings seems suggested of an inapparent physiologic role of prolaction in the regulation of ovulatory menstrual cycle.

Premature rupture of the membrane represents the greatest risks of prematurity, maternal and fetal infection and perinatal mortality. Spontaneous labor develops in most cases within 24 hours after premature rupture of the membrane, but maternal infectious morbidity occurs if rupture of the membranes persists for up to 48 hours. The management to premature rupture of the membrane has created as much controversy as has any other problem in obstetrics. A retrospective study of 166 cases of premature rupture of the membrane admitted to Ewha Womans University Hospital during the 2 year interval 1984 to 1985 was performed to gain clinical data. The results were as follows; 1) The incidence of premature rupture of the membranes was 3.6%. 2) The incidence of premature rupture of the membranes in premature delivered fetuses(308 cases) was 23.1%. 3) The premature rupture of the membranes was highest between 25-29 years of age. 4) The primigravida and multigravida of premature rupture of the membranes were 70.5% and 29.5% respectively. 5) There were anemia(24.4%), C.P.D.(13.3%) and preeclampsia(12.8%) in maternal complications. 6) The overall incidence of breech presention in premature rupture of the membranes was 5.5%. 7) The cesarean section rate was 41.6% and its indications were C.P.D., abnormal presentation and fetal distress in order. 8) The neonatal birth weight between 2500-2999 gm was 25.6%. 9) The longer the latent period of premature rupture of the membranes is, one minite apgar score under 6 is increased. 10) Causes of perinatal morality of premature rupture of the membrane were R.D.S(11.8%) with prematurity and no correlation with latent period of PRM. 11) The incidence of amnionitis was 5.4% and the longer the latent period is, the higher the maternal morbidity is. 12) There was no significant difference in the incidence of maternal and neonatal morbidity and perinatal mortality in antibiotic treated and untreated groups of the mothers complicated with premature rupture of the membranes.

This stdy is about cinical evalution and statistical analysis of 435 cases who were admitted and treated at department of obstetrics and gynecology, Ewha Womans University hospital from Jan. 1, 1971 to Dec. 31, 1979. The results were as follows; 1) The incidence of ectopic pregnancies was 1 in 38 deliveries. 2) The most frequent age group was in 25-34 years of age. The'youngest patient was 18 year old and the oldest patient was 49 year old. 3) igravida was 11.7%, ipara was 24.8% and 65.5% of total were experienced artificial abortion 4) The mean duration of infertility was 1 year 9 monthes and 3 cases were 9 years or more of inferility. 5) A history of previous laparotomy was 14.3%, repeat ectopic pregnancy was 7.8% and previous inflammatory disease was 8.7%. 6) Symptom was developed at 6.5 gestation week (mean). Symptoms were lower abdominal pain 94.7%, vaginal spotting in 84.7% , and shock state in 23.5% On pelvic examination, abdominal tenderness in 60.1, abdominal distension in 26.0%, and palpable adnexal mass in 39.2%. 7) Gravindex test was pregnant in 56% and culdocentesis was positive in 95.3% 8) Implantation site were tubal pregnancy in 91.7%, ovarian pregnancy 0.7%, cervical pregnancy 2.5% and cornual pregnancy 4.8%. 9) 69.5% of the cases were treated with salpingectomy and salpingoophorectomy was performed in 11%. 10) Of 435 cases, 1 death occurred who was dead at arrival.