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Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

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Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

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Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.

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OBJECTIVE: To evaluate the association of level of CA-125 and severity of dysmenorrhea with lesion depth in adenomyosis. METHODS: Sixty-eight women who had undergone hysterectomy and were found to have pure adenomyosis on histopathologic examination were reviewed retrospectively. Specimens were stratified according to the degree of adenomyosis penetration into 4 groups: group A consisted of specimens with adenomyosis penetration into myometrium of up to 25%; group B, 26-50%; group C, 51-75%, and group D, >75%. All women were submitted to serum determination of CA-125. Severity of dysmenorrhea was assessed by means of a modification of 10-point verbal rating scale. RESULTS: Each group was not correlated with severity of dysmenorrhea (p=0.7394 Fisher's exact test). The means of serum CA-125 levels was increased corresponding to depth of adenomyosis (p=0.0441 ANOVA test). CONCLUSION: In this study, serum CA-125 level is associated with the depth lesion and severity of dysmenorrhea is not. Therefore, the level of serum CA-125 might be useful indicator in management of adenomyosis before surgery.

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OBJECTIVE: It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorf's suture in cold knife conization and to investigate various measures employed to reduce blood loss. METHODS: The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. RESULTS: Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. CONCLUSION: Cold knife conization using Sturmdorf's suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several days? admission is needed and the other alternative methods seem to be more convenient.

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OBJECTIVE: To investigate the efficacy of PAP smear as a screening tool for cervical cancer by evaluating the result of a review of 34,970 cases of PAP smear at Pohang St. Mary's Hospital. METHODS: From January, 1992 to December, 2001 cytologic examination of 34,970 women were analysed and the results were reviewed. RESULTS: 1. The average of annual screening rate was 14.8%. 2. Abnormal cytology rate was 2.02% including 1.02% of ASCUS, 0.99% of class III, 0.20% of class IV and 0.30% of class V. 3. 8.28% of the women screened were aged less than 30 years, 31.8% or=70 years respectively. 4. Of the 188 patients who had a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS), 127 (68%) were followed up, 99 (78%) were normal and 28 (22%) had squamous intraepithelial lesion. 5. The prevalence rate of cervical neoplasia confirmed by histopathology for the past 10 years was 1.53%. Of those the rate of invasive cervical cancer was 0.65%. 6. The false negative rate was 17.3% and false positive rate was 4.5%. 7. The sensitivity and specificity and positive predictive value of PAP smear were 82.7%, 95.5% and 90.2%. CONCLUSION: For PAP smear to be early detecting tool for cervical cancer, continuous effort is required to raise annual screening rate, to lower the false negative rate, and to raise the sensitivity of PAP smear.

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Although arteriovenous malformation (AVM) of the uterus is a very rare cause of menometrorrhagia or postmenopausal vaginal bleeding, it is notable to think in the assessment of a woman with abnormal uterine bleeding because correct diagnosis can yield proper therapy to be designed and avoid hysterectomy in women who want to continue their reproductive capacity. AVM may be congenital or acquired. In times past, the diagnosis is usually made after hysterectomy, but currently it may be made before treatment by ultrasound, pelvic angiography, or magnetic resonance imaging. We have experienced one case of AVM of uterus, which is diagnosed after hysterectomy.

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Trisomy 13 (Patau syndrome) is rare and usually fatal if contracted within the first six months of life. We report a case of a male fetus with the typical features of Patau syndrome. He was terminated in a 27-year-old mother at the gestational age of 32+4 weeks. In chromsomal analysis by GTG banding technique, the karyotype of the fetus was 46,XY,rec(13) dup(13q)inv(13)(p13q21.3)(=partial trisomy 13q); and his mother's karyotype was 46,XX, inv(13)(p13q21.3)(=pericentric inversion). His father had normal karyotype, 46,XY. Ultrasonography showed fluid-nature content, which was occupying the entire intracranium, but preserving the brain stem and cerebellum. Postmortem examination disclosed holoprosencephaly, hydrocephalus, a single nostril, bilateral anophthalmia, ventricular septal defect, and a single umbilical artery.

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OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and treatment of cervical neoplasia. METHODS: Sixty patients were divided into diagnostic and therapeutic conization group and then indication of conization, PAP smear, colposcopy directed biopsy, cone margin and residual lesion of each group were compared respectively. RESULTS: If the difference of PAP and colposcopy directed biopsy was 2 grades or more, upper limit of the lesion was invisible, squamocolumnar junction was not seen, PAP V or invasive cancer was suspected, diagnostic conization was performed in 22 patients. Six cases of follow-up group had cone margin (-) and no recurrence. Sixteen cases of immediate TAH (total abdominal hysterectomy) group had 2 cases of cone margin (+) with residual disease. There were 4 cases of cone margin (-) with residual lesion. If the difference of PAP and colposcopy directed biopsy was 1 grade or less, upper limit of the lesion was visible, squamocolumnar junction was seen and invasive cancer was ruled out, therapeutic conization was performed in 38 cases. All of therapeutic conization group had cone margin (-). Thirty two cases were follow up group and six cases were immediate TAH group. Three of follow up group had recurrences and delayed TAH was performed. There was no residual lesion in the specimen of immediate TAH group. CONCLUSION: The precise dignosis and treatment of cervical neoplasia was capable with cold knife conization. The more aggressive lesion or the more cases of cone margin (+) was diagnosed, the more residual lesion was found. Thorough follow up should be done after treatment of cervical neoplasia because of the possibility of residual disease even after documentation of cone margin (-).

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Peripartum cardiomyopathy is defined as a syndrome of cardiac failure occurring in tbe latter part of pregnancy or in the puerperium, without obvious cause and without prior evidence of heart disease. Despite its infrequency, this clinical problem may have devastating consequences upon maternal and fetal outcome. It is important to recognize the association of cardiac failure and pregnancy as a separate syndrome so that, once identified, peripartum cardiomyopathy can be treated promptly and aggressively. We experienced two cases of peripartum cardiomyopathy, and report these cases with a brief review of the literatures.

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We have experienced two cases of Wernicke's encephalopathy associated with hypere-mesis gravidarum. Delay in it's diagnosis caused a protracted illness and persisting neurol-ogic deficits. Because of its association with chronic alcoholism, possibility of Wernicke's encephalopathy may not be considered in early stage of disease. The clinical feature, the principle of management and the prevention of Wernicke's encephalopathy are discussed.

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From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym University. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24~42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1~17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), laparoscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postoperatively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30~34 years, 71.4 % in 35~39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical differences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmicisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4~6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5~10 years, 44.4 % in 11~15 years(p = 0.230).

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Suction curettage is a relatively safe procedure to induce abortion of first trimester pregnancy with a very low complication rate. But, in order to do that, cervix should be dilated enough to pass operating devices. We experienced a case of first trimester pregnancy terminated successfully using transvaginal misoprostol when suction curettage was failed due to severely cervical stenosis after LEEP conization.

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We reviewed the cases of five patients with colonic inertia who were treated with total abdominal colectomy and ileorectal anastomosis at the Wonkwang University Hospital from June 1994 to november 1995. All of the 5 patients with chronic constipation underwent, a colon study, colonoscopy, anorectal manometry, defecography, balloon expulsion test, and a study of the total and segmental colonic transit of radioopaque markers to diagnose the colonic inertia. The ratio of male to female was 1:4, the mean age 58 years, the average duration of symptom 41.8 months, and the average time between bowel movements 18.4 days. There was no specific operative morbidity and mortality and the average hospital stay was 14 days. At follow-up ranging from 3 months to 20 months they had excellent stool control and 1-2 bowel movements per 1-2 days. All were satisfied with the procedure.

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