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Objective: To evaluate vascular endothelial growth factor (VEGF) as a marker for predicting lymph node metastasis and an independent prognostic factor of early-stage cervical carcinoma., Methods: One hundred thirty-five women with stage IB-IIA cervical carcinoma had radical abdominal hysterectomies and pelvic lymph node dissections. Intratumoral cytosol VEGF concentrations were assayed with enzyme immunoassay. Histopathologic items and cytosol VEGF-influencing clinical outcomes were compared., Results: Twenty-two women (16.3%) who had disease recurrence had higher levels of cytosol VEGF (1020 versus 112 pg/mg protein, P <.001) than those without recurrence. Using a cutoff value of 400 pg/mg protein resulted in best sensitivity of 75%, best specificity of 70%, positive predictive value of 41%, and negative predictive value of 92%. Only overexpressed cytosol VEGF (hazard ratio 6.44, P <.001) was an independent prognostic factor of disease-free survival. The overexpressed cytosol VEGF (hazard ratio 4.50, P =.021) and positive lymphovascular emboli (hazard ratio 4.11, P =.045) were independent prognostic factor of overall survival., Conclusion: Cytosol VEGF might be a biomarker for the status of pelvic lymph nodes in early-stage cervical carcinoma and an independent prognostic indicator of its outcome.

Background: If medical management is unsuccessful in controlling postpartum hemorrhage, conservative surgical intervention or cesarean hysterectomy is required., Technique: Hemostatic multiple square suturing using a straight number 7 or number 8 needle and number 1 chromic catgut is a new surgical technique to approximate anterior and posterior uterine walls, especially in areas where there is heavy bleeding. It controls postpartum hemorrhage by attachment and compression of the hemorrhage site of the endometrium or myometrium., Experience: We used this technique in 23 women with postpartum hemorrhages at cesarean who did not respond to conservative treatment. In all 23 cases, bleeding decreased markedly and hysterectomy was avoided. All resumed normal menstrual flow after surgery. In four cases, further pregnancy was achieved after this method was used., Conclusion: Hemostatic multiple square suturing is an easy, safe, conservative surgical alternative to hysterectomy for treating uncontrollable postpartum hemorrhage.

Objective: To quantitate vascular endothelial growth factor of cervical carcinoma and elucidate its clinical correlation., Methods: Intratumoral protein levels of vascular endothelial growth factor were measured in 104 cervical cancer patients and in 30 cervical tissue specimens of benign gynecologic diseases as controls. The concentrations were correlated with clinical and pathologic characteristics., Results: The median concentrations of vascular endothelial growth factor in cervical cancer tissues were higher than those in benign cervical tissues (180.0 versus 0.0 pg/mg of protein, P < .001). Tumors larger than 4 cm (1030.0 versus 118.0 pg/mg of protein, P < .001) and with deep stromal invasion (364.0 versus 111.0 pg/mg of protein, P = .016) had higher levels than those smaller than 4 cm or with superficial stromal invasion. Higher levels were also found in tumors with lymphovascular emboli (568.0 versus 118.0 pg/mg of protein, P = .006), parametrial invasion (582.0 versus 117.0 pg/mg of protein, P = .04), and pelvic lymph node metastasis (759.5 versus 121.0 pg/mg of protein, P = .002) than in those without. The protein levels of vascular endothelial growth factor correlated positively with tumor sizes (r = 0.340, P < .001). Tumors with overexpressed VEGF were larger (3.35 +/- 1.17 versus 2.13 +/- 1.28 cm, P < .001) and had higher incidence of deep stromal invasion (20 of 57 versus 6 of 47, P = .009), lymphovascular emboli (15 of 33 versus 11 of 71, P = .011), parametrial invasion (15 of 32 versus 11 of 72, P = .002), and lymph node metastasis (10 of 20 versus 16 of 84, P = .004)., Conclusion: Intratumoral protein level of vascular endothelial growth factor in cervical cancer tissue correlates well with local tumor progression and tumor metastasis. Vascular endothelial growth factor might be a marker for evaluating disease severity.

Objective: To determine whether resistance index values obtained by color Doppler ultrasound contribute to the accuracy in diagnosing ovarian malignancies., Methods: Four hundred ten patients with ovarian neoplasms referred for color Doppler ultrasound evaluation were enrolled, excluding patients examined during the luteal phase. Resistance index of the intra-tumor arteries was measured by color Doppler ultrasound. The corresponding clinical and histopathologic information was recorded. For statistical determinations, we used the Yates corrected chi 2 analysis, Fisher exact test, Student t test, and linear regression analysis., Results: Satisfactory intra-tumor artery waveforms were obtained in 96.1% (99 of 103) of ovarian malignancies. Resistance index values varied at 0.23-0.82. Regression analysis of resistance index values on tumor size and amount of ascites demonstrated a linear association (R = 0.498 and 0.362, respectively; P < .01 in both). If we regard a resistance index of 0.4 as a cutoff value, the overall sensitivity and specificity in detecting malignancy were 68.0 and 97.4%, respectively. Primary ovarian malignancies exhibited significantly more false negatives (30 of 79) than malignancies metastasized to the ovary (three of 24) (P = .018). Malignancies containing mainly cystic components exhibited more false negatives (20 of 41) than did tumors with primarily solid components (13 of 62) (P < .01). Significantly more false negatives were encountered in malignancies with larger diameters (greater than 10 cm) compared to smaller ones (27 of 63 versus six of 40; P < .01), and in malignancies accompanied by considerable ascites (greater than 1000 mL) (13 of 25 versus 20 of 78; P < .05)., Conclusions: Tumor origin, size, component nature, and amount of ascites contributed to the accuracy in diagnosing ovarian malignancies using resistance index values obtained by color Doppler ultrasound.

Objective: To determine the frequency of intrauterine rubella infection in Taiwan., Methods: One hundred three pregnant women with evidence of rubella infection were enrolled. Congenital rubella infection was diagnosed by testing specific immunoglobulin (Ig) M in fetal cord serum obtained from funipuncture or amniotic fluid culture. The fetal outcomes were evaluated by ultrasonic examination, specific antibody detection in cord blood at birth, and complete physical examination during early childhood., Results: Prenatal diagnosis was possible in 95 of 103 fetuses, 93 by funipuncture and two by amniocentesis. Five intrauterine rubella infections were detected prenatally, and another one was diagnosed after birth. The intrauterine infection rates were 10.0, 11.8, 2.9, and 6.5% after maternal infection at 1-10, 11-14, 15-19, and 20-29 gestational weeks, respectively. Among the six fetuses with serologic evidence of congenital infection, one had congenital rubella syndrome with sensorineural deafness, two were terminated during the second trimester, two others were normal, and one was lost to follow-up. With the exception of the infant with clinical congenital rubella syndrome, no evidence of rubella defects was found in the other 81 children who received follow-up to 2-4 years old., Conclusion: The risk of congenital rubella infection in seropositive pregnant women is relatively low in Taiwan.

Objective: To determine the effect of cardiac valve replacement on pregnancy outcome., Methods: We reviewed retrospectively 151 pregnancies in 88 women: 56 pregnancies in 31 women with mechanical valves and anticoagulation therapy, and 95 pregnancies in 57 women with porcine tissue valves. Student t, chi 2, and Fisher exact tests were used for analysis., Results: There was a significantly greater rate of fetal loss in patients with mechanical valve replacements than in those with porcine tissue valves (27.7 versus 12.3%, respectively; P < .05). No significant differences were found in prematurity (5.9 versus 7.7%) or small for dates infants (8.8 versus 10.8%). Two congenital anomalies were noted in the mechanical valve group. Maternal complications in patients with mechanical valves included valve dysfunction (three), thromboembolism (three), abruptio placentae (two), postpartum hemorrhage (two), severe oligohydramnios (two), and puerperal fever caused by brain abscess (one). Four cases of valve dysfunction and one of infectious endocarditis complicated the condition of patients with porcine tissue valves. The 10-year graft survival rate in the porcine valve group was lower following two subsequent pregnancies (16.7%) than following one (54.8%)., Conclusion: Fewer fetal and maternal complications occurred in subsequent pregnancies after porcine valve replacement. However, the need for reoperation is more likely, and pregnancy might accelerate the degenerative process.