Publications by authors named "Chan Joo Kim"

38 Publications

Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study.

J Clin Med 2021 Oct 11;10(20). Epub 2021 Oct 11.

Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer.

Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes.

Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40-59 years, aOR = 1.413; 95% confidence interval (CI) 1.203-1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239-1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27-2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer ( < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years.

Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.
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http://dx.doi.org/10.3390/jcm10204647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8539504PMC
October 2021

Health Care Provider Perceptions of Facilitators and Barriers to Human Papillomavirus Vaccination Delivery in Five Countries.

Sex Transm Dis 2021 08;48(8):557-564

Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Background: National human papillomavirus (HPV) vaccination programs could reduce global cervical cancer morbidity and mortality with support from health care providers. We assessed providers' perceptions of HPV vaccination in 5 countries.

Methods: We identified providers from 5 countries where national HPV vaccination programs were at various stages of implementation: Argentina, Malaysia, South Africa, South Korea, and Spain. Providers authorized to administer adolescent vaccines completed an in-depth survey, reporting perceptions of barriers and facilitators to initiating and completing HPV vaccination, and logistical challenges to HPV vaccination.

Results: Among 151 providers, common barriers to HPV vaccination initiation across all countries were parents' lack of awareness (39%), concerns about vaccine safety or efficacy (33%), and cost to patients (30%). Vaccination education campaign (70%) was the most commonly cited facilitator of HPV vaccination initiation. Common barriers to series completion included no reminder system or dosing schedule (37%), loss to follow-up or forgetting appointment (29%), and cost to patients (25%). Cited facilitators to completing the vaccine series were education campaigns (45%), affordable vaccination (32%), and reminder/recall systems (22%). Among all countries, high cost of vaccination was the most common logistical challenge to offering vaccination to adolescents (33%).

Conclusions: Incorporating provider insights into future HPV vaccination programs could accelerate vaccine delivery to increase HPV vaccination rates globally.
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http://dx.doi.org/10.1097/OLQ.0000000000001389DOI Listing
August 2021

Survival rates of patients who undergo minimally invasive surgery for endometrial cancer with cervical involvement.

Int J Med Sci 2021 21;18(10):2204-2208. Epub 2021 Mar 21.

Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Compare the oncologic outcomes of patients with intermediate-risk endometrial cancer who were staged by minimally invasive surgery with the outcomes of patients who underwent open surgery. Data from 206 patients with intermediate-risk endometrial cancer who were treated between January 2009 and January 2019 were reviewed. The patients' data were retrieved from five institutions. The patients were divided into two groups: those who underwent open surgery and those who underwent minimally invasive surgery. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Among the 206 patients included in this study, 76 underwent open surgery (36.9%) and 130 underwent MIS (63.1%). In patients with stage IB endometrial cancer, the recurrence rate, disease-free survival, and overall survival were not significantly different between those who underwent minimally invasive surgery and those who underwent open surgery. However, in patients with stage II endometrial cancer, the recurrence rate was significantly higher among those who underwent minimally invasive surgery (37.5% vs. 5.3%, p = 0.013). Patients with stage II endometrial cancer who underwent minimally invasive surgery had a significantly lower disease-free survival (p = 0.012) than those who underwent open surgery, however, the overall survival (p = 0.252) was similar between the two groups. Minimally invasive surgery results in less favorable survival outcomes than open surgery in patients with stage II endometrial cancer.
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http://dx.doi.org/10.7150/ijms.55026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040417PMC
March 2021

Imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease in uterine carcinosarcoma.

J Obstet Gynaecol 2021 Nov 1;41(8):1268-1270. Epub 2021 Mar 1.

Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

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http://dx.doi.org/10.1080/01443615.2020.1863933DOI Listing
November 2021

Minimally invasive surgery for patients with advanced stage endometrial cancer.

Int J Med Sci 2021 1;18(5):1153-1158. Epub 2021 Jan 1.

Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Compare the oncologic outcomes of patients with advanced stage endometrial cancer who were staged by minimally invasive surgery with the outcomes of patients who underwent open surgery. Data from 138 patients with advanced stage endometrial cancer who were treated between January 2009 and January 2019 were reviewed. The patients' data were retrieved from five institutions. The patients were divided into two groups: those who underwent open surgery and those who underwent minimally invasive surgery. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Among the 138 patients included in this study, 72 underwent open surgery (52.2%) and 66 underwent MIS (47.8%). In patients with advanced-stage endometrial cancer, the recurrence rate was significantly higher among those who underwent open surgery (43.1% vs. 25.8%, p = 0.033). Patients with advanced-stage endometrial cancer who underwent open surgery had a significantly lower disease-free survival (p = 0.029) than those who underwent minimally invasive surgery, however, the overall survival (p = 0.051) was similar between the two groups. Minimally invasive surgery showed better survival outcomes when compared to open surgery in advanced-stage EC patients irrespective of the histologic type.
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http://dx.doi.org/10.7150/ijms.52293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847628PMC
October 2021

Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma.

J Clin Med 2020 Sep 8;9(9). Epub 2020 Sep 8.

Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea.

Background: Recent studies have demonstrated that the tumor microenvironment, known to be influenced by inflammatory cells, plays a crucial role in cancer progression and clinical outcome of patients. The objective of the present study was to investigate prognostic values of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for disease-free survival (DFS) and overall survival (OS) of uterine sarcoma patients.

Methods: Ninety-nine patients with uterine sarcoma treated in eight multicenter institutions over the last 20 years were retrospectively analyzed. Curves of DFS and OS were calculated using the Kaplan-Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model.

Results: High NLR was significantly associated with worse DFS ( = 0.007) and OS ( = 0.039). Advanced stage ( = 0.017) and high mitotic index ( = 0.036) retained their prognostic significance for DFS. Other clinical variables, including PLR, CA125, and lactate dehydrogenase (LDH) failed to show significant impact.

Conclusions: Our findings showed that an elevated preoperative NLR was associated with poor clinical outcome in uterine sarcoma patients. Our results suggest that high NLR in early-stage uterine sarcoma patients might indicate that such patients need more intensive treatments.
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http://dx.doi.org/10.3390/jcm9092898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564429PMC
September 2020

Persuasive messaging for human papillomavirus vaccination by adolescent providers in a five-country multi-site study.

Int J Gynecol Cancer 2019 02 4;29(2):250-256. Epub 2019 Jan 4.

Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA

Objective: Strong persuasive messaging by providers is a key predictor for patient acceptance of prophylactic human papillomavirus vaccination. We aimed to determine optimal messaging to promote human papillomavirus adolescent vaccination across different geographical sites.

Methods: Adolescent providers (n = 151) from Argentina, Malaysia, South Africa, South Korea, and Spain were surveyed on messages, family decision makers, and sources of communication to best motivate parents to vaccinate their adolescent daughters overall, and against human papillomavirus. Multivariate logistic regression assessed the likelihood of recommending messages specifically targeted at cervical cancer with providers' characteristics: gender, medical specialization, and previous administration of human papillomavirus vaccination.

Results: Mothers were considered the most important human papillomavirus vaccination decision makers for their daughters (range 93%-100%). Television was cited as the best source of information on human papillomavirus vaccination in surveyed countries (range 56.5%-87.1%), except Spain where one-on-one discussions were most common (73.3%). Prevention messages were considered the most likely to motivate parents to vaccinate their daughters overall, and against human papillomavirus, in all five countries (range 30.8%-55.9%). Optimal messages emphasized cervical cancer prevention, and included strong provider recommendation to vaccinate, vaccine safety and efficacy, timely vaccination, and national policy for human papillomavirus vaccination. Pediatricians and obstetricians/gynecologists were more likely to cite that the best prevention messages should focus on cervical cancer (OR: 4.2, 95% CI: 1.17 to 15.02 vs other medical specialists).

Conclusions: Provider communication messages that would motivate parents to vaccinate against human papillomavirus were based on strong recommendation emphasizing prevention of cervical cancer. To frame convincing messages to increase vaccination uptake, adolescent providers should receive updated training on human papillomavirus and associated cancers, while clearly addressing human papillomavirus vaccination safety and efficacy.
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http://dx.doi.org/10.1136/ijgc-2018-000004DOI Listing
February 2019

Adolescent providers' knowledge of human papillomavirus vaccination age guidelines in five countries.

Hum Vaccin Immunother 2019 4;15(7-8):1672-1677. Epub 2019 Apr 4.

a Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.

: To examine provider knowledge of HPV vaccination age guidelines in five countries. : A total of 151 providers of adolescent vaccinations in Argentina, Malaysia, South Africa, South Korea, and Spain were interviewed between October 2013 and April 2014. Univariate analyses compared providers' understanding of recommended age groups for HPV vaccination to that of each country's national guidelines. : In three of five countries surveyed, most providers (97% South Africa, 95% Argentina, 87% Malaysia) included all nationally recommended ages in their target age group. However, a relatively large proportion of vaccinators in some countries (83% Malaysia, 55% Argentina) believed that HPV vaccination was recommended for women above age 26, far exceeding national guidelines, and beyond the maximum recommended age in the United States. National median minimum and maximum age recommendations cited by the respondents for HPV vaccination were 11 and 29 years in Argentina (national guideline: 11-14), 13 and 48 years in Malaysia (guideline 13-14), 8 and 14 years in South Africa (guideline 9-14), 10 and 20 years in South Korea (guideline 11-14), and 11 and 12 years in Spain (guideline 11-14). In all countries, a higher percentage of vaccinators included all nationally recommended ages for vaccination, as compared to providers who did not administer HPV vaccination. : Overall, a substantial proportion of providers incorrectly reported their country's age guidelines for HPV vaccination, particularly the upper age limit. As provider recommendation is among the strongest predictors of successful vaccination uptake among adolescents, improved education and clarification of national guidelines for providers administering HPV vaccination is essential to optimize prevention of infection and associated disease.
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http://dx.doi.org/10.1080/21645515.2018.1558688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746518PMC
February 2020

Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries.

Cancer Causes Control 2018 Nov 4;29(11):1115-1130. Epub 2018 Oct 4.

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.

Purpose: The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.

Methods: Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9-14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers' attitudes towards a 2-dose schedule were assessed through focus group discussions.

Results: Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.

Conclusions: Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.
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http://dx.doi.org/10.1007/s10552-018-1085-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589352PMC
November 2018

HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries.

J Pediatr Adolesc Gynecol 2018 Dec 12;31(6):575-582.e2. Epub 2018 Jul 12.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Electronic address:

Study Objective: To assess adolescent health care providers' recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries.

Design: In-depth interviews of adolescent health care providers, 2013-2014.

Setting: Five countries where HPV vaccination is at various stages of implementation into national programs: Argentina, Malaysia, South Africa, South Korea, and Spain.

Participants: Adolescent health care providers (N = 151) who had administered or overseen provision of adolescent vaccinations (N = Argentina: 30, Malaysia: 30, South Africa: 31, South Korea: 30, Spain: 30).

Main Outcome Measures: Frequency of HPV vaccination recommendation, reasons providers do not always recommend the vaccine and facilitators to doing so, comfort level with recommending the vaccine, reasons for any discomfort, and positive and negative aspects of HPV vaccination.

Results: Over half of providers 82/151 (54%) recommend HPV vaccination always or most of the time (range: 20% in Malaysia to 90% in Argentina). Most providers 112/151 (74%) said they were comfortable recommending HPV vaccination, although South Korea was an outlier 10/30 (33%). Providers cited protection against cervical cancer 124/151 (83%) and genital warts 56/151 (37%) as benefits of HPV vaccination. When asked about the problems with HPV vaccination, providers mentioned high cost 75/151 (50% overall; range: 26% in South Africa to 77% in South Korea) and vaccination safety 28/151 (19%; range: 7% in South Africa to 33% in Spain). Free, low-cost, or publicly available vaccination 59/151 (39%), and additional data on vaccination safety 52/151 (34%) and efficacy 43/151 (28%) were the most commonly cited facilitators of health provider vaccination recommendation.

Conclusion: Interventions to increase HPV vaccination should consider a country's specific provider concerns, such as reducing cost and providing information on vaccination safety and efficacy.
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http://dx.doi.org/10.1016/j.jpag.2018.06.010DOI Listing
December 2018

The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy.

Arch Gynecol Obstet 2018 03 30;297(3):691-697. Epub 2017 Dec 30.

Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Purpose: To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure.

Methods: A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups.

Results: A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P = 0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate.

Conclusion: Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.
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http://dx.doi.org/10.1007/s00404-017-4637-9DOI Listing
March 2018

Persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy: a rare case of peritoneal trophoblastic implant.

Obstet Gynecol Sci 2017 Nov 24;60(6):616-620. Epub 2017 Oct 24.

Department of Obstetrics and Gynecology, St. Paul's Hospital, College of medicine, The Catholic University of Korea, Seoul, Korea.

Peritoneal trophoblastic implant can occur after treatment of ectopic pregnancy. Similarly, after termination of intrauterine pregnancy, trophoblastic implants are rare but can be a complication of perforation during dilatation and curettage. We report an extremely rare case of trophoblastic implant on the myometrium, ovarian surface, and peritoneal wall 4 months after uncomplicated dilatation and curettage. To the best of our knowledge, this is the first case of peritoneal trophoblastic implant following dilatation and curettage without uterine perforation. Knowledge of this case is useful for the management of patients with persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy.
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http://dx.doi.org/10.5468/ogs.2017.60.6.616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694740PMC
November 2017

Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries.

Papillomavirus Res 2017 Jun 6;3:126-133. Epub 2017 Apr 6.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599, USA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.

Introduction: Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls.

Methods: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country.

Results: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs.

Conclusions: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.
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http://dx.doi.org/10.1016/j.pvr.2017.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608022PMC
June 2017

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study.

BMJ Open 2017 04 3;7(4):e013868. Epub 2017 Apr 3.

Department of Obstetrics and Gynecology, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Objectives: Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans.

Design: Nationwide cross-sectional study.

Setting: Republic of Korea.

Participants: 3734.

Main Outcome Measures: The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis.

Results: The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job status among women aged 15-39 were associated with participation in cervical cancer screening (p<0.05). After age stratification, the associated factors differed by age groups. Moreover, a dose-response between participation in cervical cancer screening and high total household income in the 30-39 age group was seen.

Conclusions: Predictive factors differed among young women (aged 15-29 vs 30-39). Thus, age-specific tailored interventions and policies are needed to increase the participation rate in screening for cervical cancer.
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http://dx.doi.org/10.1136/bmjopen-2016-013868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387966PMC
April 2017

Toll-like receptor 2 gene polymorphisms in Korean women with human papillomavirus-related cervical neoplasia.

Acta Obstet Gynecol Scand 2016 07 18;95(7):829-35. Epub 2016 Apr 18.

Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Introduction: The aim of this study was to investigate the association between Toll-like receptor 2 (TLR2) gene polymorphisms and human papillomavirus (HPV)-related cervical neoplasia in Korean women.

Material And Methods: Peripheral blood samples collected from 127 patients with HPV-related cervical neoplasia and 175 healthy women were genotyped for the TLR2 -16934, +1350, intron1, and 3' untranslated region (UTR) polymorphisms using the polymerase chain reaction and restriction fragment length polymorphism method.

Results: The TLR2 -16934 A/A, intron1 A/A, and +1350 T/C genotypes were more frequent in patients than in controls [odds ratio (OR) = 2.1, 95% CI = 1.302-3.475, p = 0.002; OR = 1.9, 95% CI = 1.168-3.169, p = 0.010; and OR = 1.9, 95% CI = 1.211-3.123, p = 0.006, respectively]. The frequencies of the TLR2 + 1350 C and 3'UTR G alleles were also higher in patients (OR = 2.0, 95% CI = 1.236-3.121, p = 0.004 and OR = 1.7, 95% CI = 1.005-3.076, p = 0.046, respectively). The genotype frequencies of TLR2 -16934 A/A and intron1 A/A increased with increasing oncogenic risk of the HPV genotype, as follows. low-risk type < high-risk type < HPV-16 and/or HPV-18 type (p = 0.008).

Conclusions: Our study provides the first evidence that TLR2 gene polymorphisms are associated with high-risk type HPV-related cervical neoplasia and may play an important role in susceptibility to HPV infection. Further large-scale and functional studies are needed to confirm the role of TLR2 gene polymorphisms in HPV-related cervical neoplasia.
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http://dx.doi.org/10.1111/aogs.12895DOI Listing
July 2016

Caffeine Intake Is Associated with Urinary Incontinence in Korean Postmenopausal Women: Results from the Korean National Health and Nutrition Examination Survey.

PLoS One 2016 22;11(2):e0149311. Epub 2016 Feb 22.

Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Republic of Korea.

Introduction: The objective of this study was to investigate whether caffeine intake is associated with urinary incontinence (UI) and quality of life (QOL) in Korean postmenopausal women.

Materials And Methods: We included 4,028 postmenopausal women who had participated in the Korea National Health and Nutrition Examination Survey IV (KNHANES IV). From the KNHANES questionnaire data, we ascertained the UI status of participants, defined as self-reported or medically diagnosed UI, and calculated their total daily caffeine intake through questions regarding the frequency of food consumption. The EuroQoL-5 Dimension (EQ-5D) descriptive system was used to evaluate QOL among the study population.

Results: The mean age of the study population was 63.19±0.25 years. Among the 4,028 women, the prevalence of medically diagnosed UI was 2.6% (n = 151), the prevalence of self-reported UI was 11.9% (n = 483), and the lifetime prevalence of UI was 15.8% (n = 639). In the study population, the presence of UI was not significantly different by age group, but daily caffeine consumption and the percentage of caffeine consumer decreased with age (P<0.001). Higher caffeine intake led to significantly higher prevalence of both medically diagnosed UI (p = 0.012) and self-reported UI (p = 0.040) in the study population. Even after adjusting for factors including age, parity, smoking status, hypertension and diabetes in logistic regression analysis, the positive association between caffeine intake and UI prevalence was observed in both medically diagnosed UI and self-reported UI (P = 0.017) among participants. In a subgroup analysis for EQ-5D (using continuous variables) in which we categorized participants into four groups according to UI presence and caffeine consumption, the EQ-5D scores were lower in the caffeine non-user group with UI than in the caffeine consumer group with or without UI.

Conclusion: In a sample of Korean postmenopausal women, the prevalence of UI increased with higher caffeine consumption. Additionally, QOL was lower in caffeine non-users with UI than in the caffeine consumer groups. However, additional prospective studies are required to identify clear causation between caffeine consumption, UI prevalence and QOL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149311PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762759PMC
July 2016

A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy.

JSLS 2015 Sep-Dec;19(4)

Department of Obstetrics and Gynecology.

Background And Objective: A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma.

Methods: This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014.

Results: The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period.

Conclusion: Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator.
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http://dx.doi.org/10.4293/JSLS.2015.00084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653583PMC
May 2016

A comparison of postoperative pain after transumbilical single-port access and conventional three-port total laparoscopic hysterectomy: a randomized controlled trial.

Acta Obstet Gynecol Scand 2015 Dec 28;94(12):1290-6. Epub 2015 Sep 28.

Department of Obstetrics and Gynecology, Catholic University of Korea, Seoul, Korea.

Introduction: The objective of this study was to compare postoperative pain between single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system and conventional multi (three)-port access total laparoscopic hysterectomy (MPA-TLH).

Material And Methods: A randomized controlled trial was conducted on 60 women who underwent SPA-TLH and MPA-TLH for benign gynecologic diseases between March 2014 and January 2015. Patients were randomly assigned to undergo SPA-TLH (n = 30) or MPA-TLH (n = 30). The variables measured included surgical outcomes and postoperative pain at 30 min and 1, 12, 24, and 48 h after surgery, assessed by the visual analog scale, bolus requirement of intravenous patient-controlled analgesia, and additional analgesic use.

Results: The two study groups did not differ in terms of patient demographics or surgical outcomes except for operative time. The SPA-TLH group had a longer operative time (p < 0.0001) compared with the MPA-TLH groups. There were no differences in pain scores between the two groups. The SPA-TLH group had significantly more intravenous analgesia requests during the 12-24 h after surgery (2.17 ± 3.05 vs. 0.79 ± 1.99; p = 0.047), more 24-48 h postoperative analgesics (0.21 ± 0.41 vs. 0.03 ± 0.19; p = 0.045), and more total additional analgesics (0.97 ± 0.94 vs. 0.45 ± 0.87; p = 0.034).

Conclusion: SPA-TLH was feasible compared with MPA-TLH but the SPA-TLH group had a longer operative time. Although there is no difference in pain based on the visual analog scale pain score, the SPA-TLH group required more analgesia to give the same postoperative pain control.
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http://dx.doi.org/10.1111/aogs.12767DOI Listing
December 2015

Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases.

Arch Gynecol Obstet 2015 Jun 9;291(6):1313-9. Epub 2014 Dec 9.

Department of Obstetrics and Gynecology, The Catholic University of Korea Daejeon St. Mary's Hospital, 520-2, Daehung-dong, Jung-gu, Daejeon, 301-723, Korea.

Purpose: To compare surgical outcomes and complications of 284 patients who had total abdominal hysterectomy (TAH), 366 patients who had multi-port access total laparoscopic hysterectomy (MPA-TLH), and 286 patients who had single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system.

Methods: A retrospective study was conducted on a cohort of women who underwent TAH, MPA-TLH, or SPA-TLH for benign gynecologic diseases at DaeJeon St. Mary's Hospital, between January 2003 and December 2013. Surgical outcomes and complications were compared between the three groups.

Results: The total operative time (min) was longest in the SPA-TLH group (188.3 ± 51.3), followed by the TAH (176.4 ± 47.9) and MPA-TLH (149.3 ± 59.5) groups (p < 0.05). The estimated blood loss (mL) did not differ between MPA-TLH and SPA-TLH (163.8 ± 168.9 vs. 176.9 ± 197.8 mL), but it was the greatest in TAH (427.1 ± 250.6, p < 0.05). The weight of the uterus (gm) was highest in TAH (375.8 ± 380.1, p < 0.05) and similar in MPA-TLH and SPA-TLH (10.1 ± 2.6 vs. 9.7 ± 2.6 cm). The hospital stay (days) was longest in the TAH (7.0 ± 2.1) and SPA-TLH (6.3 ± 2.0) groups, followed by the MPA-TLH (5.5 ± 2.0) group (p < 0.05). The major complication rate was 2.5 % (7 cases) in the TAH group, 5.5 % (20 cases) in the MPA-TLH group, and 0.7 % (2 cases) in the SPA-TLH group. In the MPA-TLH group, the complication rate of the first half of the cases was significantly higher than in the latter half of cases, especially with regards to vaginal cuff dehiscence (p < 0.05). In the SPA-TLH group, no statistically significant difference was found between the two sub-groups.

Conclusions: Our study showed that MPA-TLH and SPA-TLH were feasible and safe when compared to TAH. Furthermore, after acquiring technical skills in laparoscopic surgery, conversion from MPA-TLH to SPA-TLH might be easier than the initial conversion from laparotomy to laparoscopy. The advantage of SPA-TLH over MPA-TLH is questionable, considering the longer learning curve; however SPA-TLH is an effective alternative for both the patient and surgeon.
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http://dx.doi.org/10.1007/s00404-014-3576-yDOI Listing
June 2015

Fetal biometry in the Korean population: reference charts and comparison with charts from other populations.

Prenat Diagn 2014 Oct 21;34(10):927-34. Epub 2014 May 21.

Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea.

Objective: The objectives of this article were to construct size charts for fetal biometry in the Korean population and to identify ethnic differences in fetal biometry.

Method: A prospective, cross-sectional study was performed with 986 fetuses between 15 to 40 weeks of gestation. The following biometric variables were measured: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and long bones lengths including the femur, tibia, humerus, and ulna. For each measurement, regression models were fitted to estimate the mean and standard deviation at each gestational age. The calculated centiles were compared with centiles from other populations using Z-scores.

Results: New charts for the Korean population were presented for the fetal biometric variables. Most of the parameters were similar to those for the Italian population. Also, in comparison with the North American and UK populations, Korean fetuses had greater BPD, HC, and AC in the first half of pregnancy but tended to measure progressively smaller with advancing gestational age. In comparison with the Hong Kong population, Korean fetuses had a longer femur length at any gestational age.

Conclusion: We present size charts for fetal biometry for the Korean population using the recommended methodology, suggesting they are different from what is reported in other ethnicities.
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http://dx.doi.org/10.1002/pd.4394DOI Listing
October 2014

Small cell neuroendocrine carcinoma of the uterine cervix presenting with syndrome of inappropriate antidiuretic hormone secretion.

Obstet Gynecol Sci 2013 Nov 15;56(6):420-5. Epub 2013 Nov 15.

Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Small cell carcinoma of the uterine cervix is rare. It is estimated that 10% of patients with small-cell lung cancer have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and hyponatremia has been reported to be significantly associated with a poor prognosis. A proportion of small cell carcinoma of the uterine cervix exhibit neuroendocrine characteristics as revealed by immunohistochemistry, However, cases presenting typical symptoms due to SIADH are extremely rare. This report of the SIADH of the uterine cervix is a rare case in the small cell carcinoma of the cervix presenting with tumor-associated paraneoplastic syndrome.
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http://dx.doi.org/10.5468/ogs.2013.56.6.420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859016PMC
November 2013

Brachial-ankle pulse wave velocity for the prediction of the presence and severity of coronary artery disease.

Clin Exp Hypertens 2014 28;36(6):404-9. Epub 2013 Oct 28.

Cardiovascular Center, Dongguk University Ilsan Hospital , Goyang , Republic of Korea .

The predictability of brachial-ankle pulse wave velocity (baPWV) for the presence and severity of coronary artery disease (CAD) was investigated by measuring baPWV in 501 subjects scheduled for coronary angiography. Severity of CAD was measured using modified Gensini stenosis score (GSS) and classified as a vessel disease score (VDS) of 0-3. The presence of CAD was defined as diameter stenosis>50%. Subjects were grouped in tertile by level of baPWV (<14, 14-17,  >17 m/s). Subjects with CAD showed higher mean age, prevalence of men and diabetes, and systolic blood pressure. The prevalence of hypertension, use of antihypertensive medications and use of statin was not different. Subjects with CAD had higher baPWV than subjects without CAD (16.70 ± 3.46 versus 15.21 ± 3.19 m/s, p<0.001). Multiple linear regression analysis showed significant correlation of baPWV and modified GSS (p=0.0337). ANCOVA adjusted with age, gender, body mass index, presence of hypertension or diabetes, status of smoking, use of antihypertensive medications and risk of hypercholesterolemia showed a statistically significant association of baPWV with VDS (p<0.0001). Highest tertile of baPWV had a statistically significant effect on the severity of CAD from an ANCOVA model. The predictive power of highest tertile of baPWV for the presence of CAD was 3.600 [95% confidence interval (CI) 1.884-6.881, p<0.0001]. It is concluded that increased baPWV is a reliable predictor of the presence and severity of CAD, suggesting that baPWV>17 m/s may be a threshold value for the presence and severity of CAD.
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http://dx.doi.org/10.3109/10641963.2013.846354DOI Listing
July 2015

What questions do people ask on a human papillomavirus website? A comparative analysis of public and private questions.

Int J Med Sci 2012 10;9(2):142-7. Epub 2012 Jan 10.

Department of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Objective: In 2004, we launched the question and answer (Q&A) section on a human papillomavirus (HPV) website (www.hpvkorea.org) that provides ample and regularly updated information about HPV. The purpose of this study is to collect data pertaining to questions posed on this website about HPV and its related diseases and analyze the type of questions and frequency before and after introduction of HPV vaccine in Korea. Using these results, we intend to determine the clinical and practical implications for doctors treating HPV and for HPV website providers.

Method: Data were collected from March 2004 to July 2011. This study analyzed all the questions that were asked on the website during this period. The questions were categorized into 2 groups, according to whether they were asked publicly or privately. The 10 categories for classification were determined on the basis of the contents of the questions by 4 researchers with medical degrees (Ph.D.) related to HPV research. The frequency of the questions was separately determined for the public and private question formats. Also, we compared the type of questions and frequency before and after introduction of HPV vaccine in Korea and evaluated the changes in the 2 groups over the 2 periods studied.

Results: Of the 3,062 subjects who visited the HPV website, 2,330 subjects asked public questions and 732 asked private questions. The most frequent question was "I have been infected with HPV, and I want to know about the treatment options for HPV infection and cervical dysplasia" (n = 1156, 37.8%), and the second most common question was "What are the transmission routes of HPV?" (n = 684, 22.3%). The third most common question was "How long does it take for HPV infection to spontaneously remit?" (n = 481, 15.7%).Of the 2,330 public questions, the most common question types pertained to the treatment of HPV and cervical dysplasia, HPV transmission, HPV remission, and risk of cervical cancer (in that order). Of the 732 private questions, the most frequent question types pertained to the HPV transmission, treatment of HPV and cervical dysplasia, genital warts, and HPV & pregnancy (in that order). The type and frequency of public and private questions showed statistical differences between the 2 groups (p < 0.001).

Conclusion: Our results show that when people consult an internet site about HPV, they actually want to seek about "treatment of HPV and cervical dysplasia", "HPV transmission", "HPV remission", "genital warts", and "risk of cervical cancer" (in this order). Also, our results showed that "genital warts" and "HPV & pregnancy" may have been considered embarrassing topics. Thus, these findings can be used to make informed recommendations for future clinical or internet-based communications with patients and the general public.
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http://dx.doi.org/10.7150/ijms.3420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258556PMC
May 2012

Cell-mediated immune response to human papillomavirus 16 E7 peptide pools in patients with cervical neoplasia.

Acta Obstet Gynecol Scand 2011 Dec 18;90(12):1350-6. Epub 2011 Oct 18.

Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objective: To identify characteristics of the cell-mediated immune (CMI) response to human papillomavirus-16 (HPV) E7 viral peptide pools to help the formulation of therapeutic vaccines.

Design: Prospective study. Population. Korean women.

Setting: University hospital.

Methods: From December 2008 to August 2010, 33 HPV-16-positive patients, seven patients exhibiting a high-risk HPV infection other than HPV-16 with grade 2/3 cervical intraepithelial neoplasm (CIN2/3), and nine healthy control donors were enrolled.

Main Outcome Measures: CMI response to synthetic HPV-16 E7 overlapping peptide pools using the IFN-γ ELISPOT assay.

Results: The E7 sequence comprising amino acids 16-55 was a major immunogenic region. The CMI response to HPV-16 E7 is highly type-specific. The follow-up CMI response may last longer than expected after the lesion is resected.

Conclusions: We found that the E7 sequence comprising amino acids 16-55 is a major immunogenic region that is critical for the T-cell-mediated immune response with CIN2/3 or cervical cancer. The identification of CMI responses to HPV-16 E7 peptide pools may provide insight into therapeutic vaccine trials for the control of HPV-associated diseases.
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http://dx.doi.org/10.1111/j.1600-0412.2011.01277.xDOI Listing
December 2011

The quadruple test for Down syndrome screening in pregnant women of advanced maternal age.

Arch Gynecol Obstet 2012 Mar 12;285(3):629-33. Epub 2011 Aug 12.

Department of Obstetrics and Gynecology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, #505 Banpodong, Sechogu, Seoul 137-040, Korea.

Purpose: The purpose of the current study was to determine whether or not the quadruple test for screening Down syndrome is an effective method to replace direct amniocentesis in pregnant women ≥ 35 years of age.

Methods: This study analyzed the screening performance of the quadruple test according to maternal age at delivery among subjects who had a quadruple screening test at 1 of 4 hospitals during a 5-year period and for whom data on fetal chromosomal abnormalities were available.

Results: The study population of 9,435 pregnant women was divided into 3 groups according to maternal age: 6,922 women were < 35 years of age; 2,284 were 35-39 years of age; and 229 women ≥ 40 years of age. The detection and false-positive rates of the quadruple screening test for Down or Edward syndrome in the 3 groups of women were 80 and 6.6%, 200 and 15.8%, and 100 and 35.3%, respectively.

Conclusions: Under conditions in which first trimester screening test is not available, the quadruple screening test is a better choice than direct amniocentesis for pregnancies complicated by advanced maternal age. When providing genetic counseling, we need to explain the accurate detection and false-positive rates of the screening test according to maternal age.
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http://dx.doi.org/10.1007/s00404-011-2052-1DOI Listing
March 2012

Specific human papillomavirus types and other factors on the risk of cervical intraepithelial neoplasia: a case-control study in Korea.

Int J Gynecol Cancer 2010 Aug;20(6):1067-73

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea.

Objective: Cervical neoplasia is attributed to a persistent human papillomavirus (HPV) infection. We performed a hospital-based, case-control study to evaluate the associations of HPV genotypes and other cofactors with cervical intraepithelial neoplasia (CIN).

Methods: A total of 158 women were enrolled after we received their informed consent, and the control group (the non-CIN group; n = 80) was selected from women at St Paul's Health Promotion Center. The CIN group (n = 78) was enrolled from the outpatient clinics at Kangnam St Mary's Hospital. Cervical intraepithelial neoplasia was confirmed with colposcopic-guided biopsy or loop electrosurgical excision procedure-conization. A structured questionnaire, Papanicolaou test, and HPV testing were completed. We compared each risk factor using chi2 tests and simple logistic regression analysis between the CIN and non-CIN groups. Finally, odds ratios (ORs) were calculated again by multiple logistic regression analysis.

Results: The most frequent HPV types in CIN were HPV-16, HPV-58, HPV-31/-33, and HPV-35/-56. The OR of the A9 group (HPV-16, HPV-31, HPV-33, HPV-35, HPV-52, HPV-58) was 22.7 (95% confidence interval [CI], 8.3-62.5), that of the A6 group (HPV-53, HPV-56, HPV-66) was 2.9 (95% CI, 1.1-7.5), and that of the A7 group (HPV-18, HPV-39, HPV-45, HPV-59, HPV-68) was 1.5. Sexual debut before 20 years old had significantly higher OR than did a sexual debut after 30 years (OR, 32.9; 95% CI, 2.8-364.7). The OR for CIN in single women versus married women was 6.2 (95% CI, 2.5-15.2). Compared with parous women (parity >3), nonparous women had a higher OR (95% CI, 1.4-16.7). On the multiple logistic regression analysis including the sexual debut age, the marital status, parity, cytology, and the HPV groups, the A9 group had a significant OR for CIN (6.1; 95% CI, 1.6-23.6).

Conclusions: The risk of CIN was higher for women infected with the HPV-A9 group after multiple logistic regression analysis. The other clinical risk factors were not significant factors of CIN.
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http://dx.doi.org/10.1111/IGC.0b013e3181e4a720DOI Listing
August 2010

Does the type of hysterectomy affect the prognosis in clinical stage I endometrial cancer?

J Obstet Gynaecol Res 2010 Jun;36(3):581-7

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea.

Aim: To determine whether clinical outcomes show a benefit from extended hysterectomy in patients with early endometrial cancer.

Methods: We reviewed the medical records of 101 patients who had endometrial cancer with clinical stage I disease. All the patients were surgically staged, and two types of hysterectomy, simple hysterectomy (SH) or extended hysterectomy (EH), were performed by surgeon's preference. The postoperative pathology findings, recurrence rate and disease-free survivals (DFS) between the two groups were compared.

Results: Sixty-six patients and thirty-five patients underwent SH and EH, respectively. At subsequent surgical staging, seven patients (10.6%) in the SH and four (11.4%) in EH group were upgraded to stage II or III disease. The surgical and pathological features were not different between the groups. Though the recurrence rate was lower in the EH group (9.09% for SH vs 2.86% for EH), it showed no statistical significance (P = 0.241). The 5-year DFS (88.2% for SH vs 96.0% for EH) showed no statistically significant difference between the groups either (P = 0.242).

Conclusion: Compared to SH, EH did not have any prognostic benefit in clinical stage I endometrial cancer. Until the therapeutic role of the EH is determined by further studies using a larger sample size, SH remains the treatment of choice in patients with early endometrial cancer, and surgeons should not perform extended operation without definite evidence of the disease.
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http://dx.doi.org/10.1111/j.1447-0756.2010.01220.xDOI Listing
June 2010

A case of advanced gynecologic pelvic tumors showing the diagnostic utility of HPV analysis.

J Gynecol Oncol 2009 Dec 28;20(4):251-3. Epub 2009 Dec 28.

Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Gynecologic malignancies may have similar histological characteristics. This may lead to difficulties in determining the origin of the cancer and to distinguish a synchronous neoplasm from a metastatic cancer in advanced cases. Recently, we treated a 59-year-old patient with adenocarcinoma of the uterine cervix, endometrium, fallopian tubes, and ovaries. It was difficult to determine whether the cancer was a single origin metastatic cancer or a synchronous neoplasm. The patient was finally diagnosed with metastatic cancer that originated from the uterine cervix by human papillomavirus (HPV) test. Here we report the case and briefly review of the medical literature.
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http://dx.doi.org/10.3802/jgo.2009.20.4.251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2799026PMC
December 2009

A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy.

Arch Gynecol Obstet 2010 Dec 27;282(6):631-8. Epub 2009 Nov 27.

Department of Obstetrics and Gynecology, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea.

Purpose: We compared the incidence of vaginal cuff dehiscence and other surgical complications after different modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications.

Methods: We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary's Hospital of Korea from March 2007 through February 2009. We evaluated the clinical outcomes of different vaginal cuff suture techniques during TLH: the widely used interrupted figure-of-eight suture and a two-layer running suture.

Results: All operations were completed successfully by laparoscopy. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuff dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted figure-of-eight suture group. However, there was no statistically significant difference in outcomes between the suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248).

Conclusions: The two-layer running suture technique was safe and effective for vaginal cuff suture during TLH, but there was no statistically significant advantage over the widely used figure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically significant increased risks of complication.
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http://dx.doi.org/10.1007/s00404-009-1300-0DOI Listing
December 2010

Human papillomavirus (HPV) type distribution in Korean women: a meta-analysis.

J Microbiol Biotechnol 2008 Apr;18(4):788-94

Department of Obstetrics and Gynecology, The Catholic University of Korea, College of Medicine, Catholic Medical Center, Seoul 137-040, Korea.

The aim of the present study is to estimate the overall prevalence and type distribution of human papillomavirus (HPV) in Korean women, through literature review and meta-analysis. We searched published data for the period between 1995 and 2007 using the following inclusion criteria; (1) studies using type-specific HPV tests, (2) data from Korean female, (3) with cytologic or pathologic results, (4) having more than 20 cases for each subgroup classified by cytologic results, and (5) HPV detection including types 16, 18, and at least one other type. In total, 18 studies (13,842 cases) published up to April 2007 were identified and selected. Adjusted overall HPV prevalence was 23.9% (95% CI: 23.8-24.1%) in women with normal cytology and 95.8% (95% CI: 95.4-96.2%) in women with cervical cancer. Type 16 was predominant regardless of cervical disease status, and type 58 occupied a significantly larger proportion in high-grade cervical intraepithelial lesions and cervical cancer in Korean women. HPV types 58, 33, and 52 together accounted for about 20% of infections in cervical cancer and high-grade intraepithelial lesions. After introduction of HPV prophylactic vaccines, extended protection, especially against types 58, 33, and 52, will be an important issue for cervical cancer prevention in Korea. The future dominant genotypes will require follow-up epidemiological studies with a large-scale, multicentered, and prospective design.
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April 2008
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