Human Cord Blood Stem Cell Therapy for Treatment of Stress Urinary Incontinence

Our objective in this study was to evaluate the safety and efficacy of transurethral cord blood stem cell injection for treatment of stress urinary incontinence in women. Between July 2005 and July 2006, 39 women underwent transurethral umbilical cord blood stem cell injection performed by one operator at a single hospital. All patients had stress urinary incontinence. The patients were evaluated 1, 3, and 12 months postoperatively. No postoperative complications were observed. 28 patients (77.8%) were more than 50% satisfied according to the Patient's Satisfaction results after 1 month, 29 patients (83%) were more than 50% satisfied according to the Patient's Satisfaction results after 3 months, and 26 (72.2%) continuously showed more than 50% improvement after 12 months. Intrinsic sphincter deficiency and mixed stress incontinency improved in the ten patients evaluated by urodynamic study. Our results suggest that transurethral umbilical cord blood stem cell injection is an effective treatment for women with all types of stress urinary incontinence.

Human Umbilical Cord Blood Mononuclear Cell Transplantation in Rats with Intrinsic Sphincter Deficiency

To evaluate the effectiveness of the human umbilical cord blood (HUCB) transplantation for the treatment of intrinsic sphincter deficiency (ISD), we analyzed the short term effects of HUCB mononuclear cell transplantation in rats with induced-ISD. ISD was induced in rats by electro-cauterization of periurethral soft tissue with HUCB mononuclear cell injection after 1 week. The sphincter function measured by mean leak point pressure was significantly improved in the experimental group compared to the control group at 4 weeks. (91.75+/-18.99 mmHg vs. 65.02+/-22.09 mmHg, P=0.001). Histologically, the sphincter muscle was restored without damage while in the control group it appeared markedly disrupted with atrophic muscle layers and collagen deposit. We identified injected HUCB cells in the tissue sections by Di-I signal and Prussian blue staining. HUCB mononuclear cell injection significantly improved urethral sphincter function, suggesting its potential efficacy in the treatment of ISD.

A comparative study of two transobturator tape procedures: 'Outside-in' (TOT) and 'inside-out' (TVT-O) for surgical treatment of female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: To compare the outcomes of the 'outside-in' (TOT) and 'inside-out' (TVT-O) transobturator tape procedures for surgical treatment of female urinary incontinence. METHODS: We enrolled 320 stress urinary incontinence women who could be followed-up and they underwent the TOT procedure (N=184) and TVT-O procedure (N=136) from January 1, 2003 to June 30, 2006. The preoperative evaluation included a history taking, physical examination, residual urine check, pad test, Q-tip test and urodynamic test. And we investigated the patients' characteristics, success rates, operation times, concomitant surgeries, hospital days, hemoglobin changes and complications. RESULTS: There were no statistically significant differences in patients' characteristics and urodynamic tests except the intrinsic sphincter deficiency rate (ISD: 5.6% vs. 30.6%, p=0.000). The success rates were similar in both groups (98.4% vs. 97.8%). Most common complication of TOT group is operation site erosion (2.1%), and TVT-O group is thigh or vaginal pain (3.6%). There were noted other complications, such as postoperative urinary retention, de novo urgency and urinary tract infection. Total complication rates of both groups were not statistically different (7.6% vs. 9.5%, p=0.415). There were no statistic differences in the postoperative complication rates of between only TOT group and TOT with colporrhaphy group (p=0.371), also between only TVT-O group and TVT-O with colporrhaphy group (p=0.692). There were no correlation with ISD and postoperative complications in TOT (p=0.373) and TVT-O group (p=0.082). CONCLUSIONS: The two procedures of transobturator tape procedure for female stress urinary incontinence appear to be equally effective and safe. However, long-term follow-up, surgeons' learning course, skill and experience for transobturator tape procedures should be evaluated at further studies.

Pregnancy outcomes in women aged 35 and older / 대한산부인과학회지

OBJECTIVE: To estimate the effect of maternal age on obstetric outcomes, a retrospective analysis was done. METHODS: Twenty six hundred and forty six women who delivered a singleton baby at our hospital from January 1, to December 31, 2004 were enrolled in this study. Subjects were divided into 3 age groups; 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Chi-square test was used to assess the effect of age on obstetrics outcome. Then the odds ratio was calculated to represent clinically meaningful risk. RESULTS: A total of 2646 women with complete data were available; 2245 (84.9%) less than 35 years of age; 350 (13.2%) 35-39 years; and 51 (1.9%) 40 years and older. Increasing age was significantly associated with chromosomal abnormalities (OR 3.9and 8.8 for ages 35-39 years and age 40 years and older, respectively), Preterm premature rupture of membranes (OR 1.3 and 3.2) and cesarean delivery (OR 2.0 and 5.5). Patients aged 35-39 years were at increased risk for placenta previa (OR 1.8) and congenital anomaly (OR 2.8) but these were not statistically significant. The rate of the preterm delivery was increased by age (OR 1.3 and 1.9 for ages 35-39 years and age 40 years and older, respectively) but it was not statistically significant (p=0.121). We did not find advanced maternal age to be associated with a statistically increased risk for preeclampsia, congenital anomaly, gestational diabetes, placenta abruption, low birth weight, macrosomia, neonatal morbidity (NICU admission), and perinatal loss. CONCLUSION: In conclusion, although the likelihood of adverse outcomes increases with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.

Microchimerism of Fetal Origin in Ovarian Tissues from Women with Pelvic Endometriosis / 대한산부인과학회지

OBJECTIVE: To investigate whether fetal microchimeric cells were detected in ovarian tissues with pelvic endometriosis. METHODS: Ovarian tissues with endometriosis were obtained from five women who had at least one live-born son and who underwent enucleation of endometriotic cyst or oophorectomy after a diagnosis of endometriotic cyst. Control tissues were obtained from five women with endometriosis who had no pregnant history. Tissue sections were analyzed with fluorescence in situ hybridization for the presence of fetal cells, defined by X and Y chromosome. RESULTS: Fluorescence in situ hybridization using paraffin-embedded ovarian specimens was performed successfully. Male cells were found in ovarian tissues from all five patients. No male cells were found in ovarian tissues from all five controls. CONCLUSION: Fetal microchimeric cells, possibly from feto-maternal cell trafficking were detected in ovarian tissues with endometriosis were obtained from women who had prior male pregnancies. Further study is necessary to understand the role of persistent fetal microchimeric cells in the progression of endometriosis.

The utility of an erythroblast scoring system and gender-independent short tandem repeat (STR) analysis for the detection of aneuploid fetal cells in maternal blood / 대한산부인과학회지

OBJECTIVE: The aim of this study was to determine whether fetal nucleated red blood cells (NRBCs) could be distinguished from maternal cells in peripheral blood using an erythroblast scoring system. Presumptive fetal NRBCs were further analyzed through the use of fluorescent PCR amplification with polymorphic STR markers to prove fetal origin. METHODS: NRBCs were isolated by density gradient separation, CD15/45 depletion, and gamma hemoglobin positive selection from peripheral blood of seven women who had undergone termination of pregnancy because of fetal trisomy 21 (n=4), 18 (n=1), and 13 (n=2). Candidate fetal NRBCs, based on four discrete morphological and hemoglobin staining criteria, were then subjected to fluorescent PCR amplification of chromosome 21 short tandem repeat (STR) markers (D21S1411, D21S11) and chromosome 18 STR markers (D18S535). RESULTS: In all cases candidate fetal NRBCs were accurately identified based on erythroblast scoring system and confirmed to be fetal in origin based on the presence of shared and non-shared polymorphic DNA alleles when compared to DNA isolated from maternal cells. Also in five cases aneuploid fetal cells in maternal blood were identified through the use of fluorescent PCR amplification with polymorphic STR markers. CONCLUSION: We were able to distinguish fetal NRBCs from maternal cells and prove fetal origin independent of gender. These results suggest that this novel combined approach to fetal cell isolation through using an erythroblast scoring system and genetic analysis by STR analysis is a promising method for noninvasive prenatal diagnostic applications.

A Case of Transverse Vaginal Septum with Microperforation Which got Pregnant by Intrauterine Insemination / 대한산부인과학회잡지

The mullerian ducts join the sinovaginal bulb at a point known as the mullerian tubercle. Canalization of the mullerian tubercle and sinovaginal bulb is necessary to give a normal vaginal lumen. If the area of junction between these structures is not completely canalized, a transverse vaginal septum will occur. This may be partial or complete and generally lies at the junction of the upper third and lower two thirds of the vagina. It occurs in about 1 per 75,000 females. Partial transverse vaginal septa have been reported in diethylstilbestrol (DES)-exposed females. In the prepubertal state, diagnosis is generally not made unless there is the development of a mucocolpos or mucometrium behind the septum. At puberty, however, if the septum is complete, hematocolpos and hematometrium may occur in a fashion similar to that seen in the imperforate hymen, except that there is no bulging at the introitus. The patient with an incomplete transverse septum may bleed somewhat but will still develop hematocolpos and hematometrium over time and may also complain of foul smelling vaginal discharge.

Childbirth with Husband

No abstract available.

A Case of Aplasia Cutis Congenita Associated with Fetus Papyraceous / 대한주산의학회잡지

No abstract available.

Follow-up Study of 119 cases of Fetal Choroid Plexus Cysts in the Second Trimester: Associated with Trisomy 18? / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical significance of fetal choroid plexus cysts (CPCs) in the second trimester, especially an association with trisomy 18. METHODS: From March 1998 through June 1999, second trimester screening ultrasonography was performed on 4,948 unselected single-ton pregnancies. CPCs were noted in 132 fetuses. Among them, detailed ultrasonography and follow-up was possible in 119 cases and they were recruited into the study. There were 91 cases of isolated CPCs and 28 cases of CPCs in high-risk population. "Isolated CPCs" were defined as: mother did not have any risk factors requiring amniocentesis and there were no other sonographic abnormalities on detailed ultrasound. "CPCs in high-risk population" were defined as: mother had any risk factor requiring karyotyping or there were any other sonographic abnormalities although she was general population. Amniocentesis was performed in 39 cases. We compared gestational age at time of detection, size, bilaterally, multiplicity, and complexity of CPCs in the group of isolated CPCs and CPCs in high-risk population (t-test, chi-square test; P0.05). Mean size (6.4 vs 6.2 mm), bilaterality (60% vs 57%), multiplicity (66% vs 57%), and complexity (8% vs 14%) of CPCs were also similar. All CPCs were disappeared irrespective of size and mean time of disappearance was 25+/-3 and 26+/-3 week, respectively (p>0.05). All cases of isolated CPCs resulted in phenotypically-normal neonates. It was confirmed by either amniocentesis or postnatal examination by the pediatrician. Among fetuses having CPCs in high-risk population, two trisomy 18 and one trisomy 21 were detected. All of them had positive result of maternal serum marker test and/or sonographic abnormalities. Remaining cases were proved normal. CONCLUSION: The risk of chromosome abnormalities is very high when CPCs are associated with other abnormalities on detailed ultrasound, indicating a clear need to offering genetic amniocentesis. As contrast, the risk of chromosome abnormalities for a case of isolated CPCs is very low, and in this series there was no trisomy 18. Therefore isolated CPCs should be considered as the indication of detailed ultrasound examination, but not routine karyotyping.

A Case of Uterine Prolapse in Pregnancy / 대한주산의학회잡지

Uterine prolapse with pregnancy is rare condition. The overall incidence is 1/10000- 15000 deliveries. The complications from uterine prolapse range from minor cervical ulceration and infection to fetal death or uterine rupture. The fetal mortality was as high as 22% mainly due to prematurity, respiratory infection. The management of this condition is focused on preventing late occurrence of prolapse during pregnancy and continued reduction. We present a case of uterine prolapse in pregnancy with a brief review of the literature.

Two Cases of Fetal Arachnoid Cyst Diagnosed by Prenatal Ultrasonography / 대한주산의학회잡지

Fetal abnormalities in central nervous system are now recognized more often with the increasing use of high-resolution prenatal sonography. Arachnoid cysts, because of their compression of adjacent brain tissue, may require neurosurgical intervention but otherwise they have a good long- term prognosis. The differential diagnosis of intracranial lesions is important to allow accurate counselling and also to optimize neonatal management. We report the two cases of fetal arachnoid cyst diagnosed with prenatal ultrasonography

Efficacy of Ferritin - folate - cyanocobalamin Supplementation during Pregnancy for Prevention of Anemia / 대한주산의학회잡지

OBJECTIVE: The purpose of this study is to evaluate the efficacy of ferritin-folate-cyanocobalamin supplementation for prevention of anemia during pregnancy. METHODS: The authors conducted a clinical investigation on 50 pregnant women from 20th to 36th gestational weeks. The cobination of cyanocobalamin coenzyme 500mg, folic coenzyme 800mcg, and ferritin 20mg constituted the supplementation. The parameters examined in first trimester as baseline, before treatment(at 20th weeks), and after treatment(at 36th weeks) were : hemoglobin, hematocrit, ferritin, mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), mean corpuscular volume(MCV), red blood cell count(RDW), folic acid, and vit. BPaired sample t-test was used for comparison. RESULTS: The results indicated a significant increase in the value of hemoglobin(p<0.05) and hematocrit(p<0.01) in comparison to before and after the treatment. The values of serum ferritin, folic acid, vitamin Bwere increased after the treatment compared to those of before the treatment, though there was no statistical significance. The results of MCV, MCH, MCHC, and RDW showed no statistically significant in comparison to before and after the treatment. CONCLUSIONS: These data indicate that supplementing ferritin 20mg-folate 800mcg-cyanocobalamine 500mcg per day from 20th to 36th weeks' gestation can increase values of hemoglobin, hematocrit, and ferritin concentration and can be cosidered as an appropriate method to prevent iron deficient anemia. It also might increase the value of folic acid and vitamin B12, concentration, but further study is stiU needed to determine whether the supplementation of folate and cyanocobalamine in combination with iron can have better eflicacy than iron alone in prevention of iron deficiency anemia.

Antenatal Diagnosis of Chorioangioma of the Placenta / 대한산부인과학회잡지

Since the placenta is an organ composed of blood vessels, it is not surprising that its primary neoplasm would be a vascular tumor. Placental tumors, primary or secondary, have been known to interfere with placental function. Chorioangioma(primary tumor of the placenta), which is the most common of them, occurs with an incidence for clinically significant ranges from 1~2.8:10000 births. These tumors are benign and are not usually associated with clinical sequelae unless they are larger than 5cm in long diameter. About one third of the large chorioangiomas may be associated with the maternal and fetal complications. For diagnosis of these lesions, the ultrasonography was used. If the chorioangioma is suspected, color doppler study is informative to confirm the presence of the vascular channels. We reviewed ultrasonograms and clinical records of seven patients who had been diagnosed as placental chrioangioma. The appropriate diagnostic tests and treatment can then be initiated in order to prolong gestation and decrease fetal mortality and morbidity.

A Case of Klinefelter Syndrome Combined with Hydrops Fetalis / 대한산부인과학회잡지

Nonimmune hydrops fetalis(NIHF) is a heterogenous disorder resulting from a vast number of underlying pathologies. Chromsomal abnormalities underlie a large percentage of cases of NIHF in most series. There are many reports identifying the association of Turner syndrome and Trisomy 21, 18, 13 with NIHF, but few reports about Klinefelter syndrome. In this article, we experienced a case of Klinefelter syndrome combined with hydrops fetalis and report the case with brief review of literature.

A Case of Endometrial Adenocarcinoma in a Double Uterus / 대한산부인과학회잡지

Endometrial adenocarcinoma in a double uterus has rarely been reported.We had a very rare case of double uterus with endometrial adenocarcinoma involving onehemiuterus and endometrial hyperplasia involving another hemiuterus. By report this case, wewant to share our experiance. The abnomal anatomy of the uterine cavities could have madeadequate biopsy difficult and endometrial cancer is clinically suspected but histology fails toconfirm the diagnosis.

Six Cases of Congenital Absence of the Vagina Managed by McIndoe Operation / 대한산부인과학회잡지

Mullerian agenesis or dysgenesis, rare developmental anomaly presenting as primary amenorrhea, is characterized by absence of vagina and absence or rudimentary development of the uterus. Anatomic anomalies of the axial skeleton and kindney often accompany this psychologically devatating condition. There are various methods of surgical treatment for congenital absence of the vagina. The six cases reviewed in this paper were all treated with McIndoe technique. All of 6 women experienced satisfactory sexual activity and were satisfied with vaginal depth following vaginal creation using a split thickness skin graft technique. Despite the existence of several alternative methods, the McIndoe technique is a relatively simple and highly successful procedure and hence is still prefered by many surgeons.

Comparison of Maternal Serum Screening Test Efficacy for Down Syndrome / 대한산부인과학회잡지

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test.Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, beta-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.

Comparison of Maternal Serum Screening Test Efficacy for Down Syndrome / 대한산부인과학회잡지

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test.Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, beta-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.