Clinical implication of salivary cortisol levels in pregnancy / 대한산부인과학회지

OBJECTIVE: The impact of maternal stress on pregnancy outcome has been a focus of research and cortisol is known as a biomarker of psychological stress. The aim of this study is to evaluate the relationship between salivary cortisol levels and pregnancy outcomes prospectively. METHODS: The subjects of this study were healthy pregnant women who collected morning samples of saliva (10~12 AM) at 10~13, 20~23 weeks of gestation, and postpartum 2 days between April 2007 to March 2008. Saliva was collected with commercial collector, Salivette(R), and cortisol level was analyzed by enzyme immunoassay. They also underwent ultrasonographic examination of umbilical and uterine artery Doppler between 20~23 weeks of gestation. Statistical analysis was assessed between salivary cortisol levels and pregnancy outcomes, including Doppler findings. RESULTS: A total 39 pregnant women collected salivary cortisol as indicated. They showed increase in cortisol level in 2nd trimester compared to 1st trimester, which decreased after delivery. Salivary cortisol level was not associated with maternal age, parity, occupation, body mass index, blood pressure, delivery mode, fetal sex, and fetal weight. However higher cortisol level was associated with lower resistance index of uterine artery, even there was no statistical significance. CONCLUSION: Our data could not show any association between salivary cortisol levels and pregnancy outcomes. Although this study presents a number of methodological and conceptual challenges, this does not necessarily preclude the use of salivary cortisol measures, but rather point to the importance of careful research design.

A study of stress reactivity in the development of chronic endometriosis / 대한산부인과학회지

OBJECTIVES: To determine whether there is an association between the characteristics of pain in endometriosis and chronic stress. METHODS AND MATERIALS: Fifteen women were diagnosed as endometriosis by diagnostic laparoscopy and 14 asymptomatic volunteers were enrolled. Case group was divided into two groups with their pain duration and severity. Saliva was collected four times a day with commercial collector, Salivette. Salivary cortisol was analyzed by enzyme immunoassay. Statistical association was assessed with Kruskal-Wallis test, Mann-Whitney U test, and repeated measures ANOVA test. RESULTS: In the curve showing diurnal changes of cortisol level, morning rise in cortisol level was significantly blunted among patients compared with control group (p<0.05). Among two patient groups, there was no significant correlation with disease severity, but with duration (p<0.05). CA 125 level, pain scaling score, and age showed no significant correlation. CONCLUSION: Morning rise in salivary cortisol level is blunted in women especially with chronic endometriosis. These is findings might be a small clues that the changes in the salivary cortisol level can be a sign of chronic stress state.

Maternal Nutritional Status at the End of Pregnancy,and Correlation among Pregnancy Weight Gain,Birth Weight and Serum Leptin Levels

The necessity of adequate pregnancy weight gain for optimal pregnancy outcome has been recognized. However, the specific components of pregnancy weight gain that might be critical for fetal growth and development have not been elucidated clearly. The purpose of this study was to investigate the correlation of pregnancy weight gain and birth weight with serum leptin levels in women delivered newborns. The subjects were recruited from K university hospital. The subject's characteristic data (age 32.1+/-4.3 y, gestational age 39.5+/-1.1wk, pre-pregnancy weight 58.0+/-8.6 kg, pregnancy weight gain 12.7+/-5.5 kg, newborn's birth weight 3.5+/-0.5 kg) were gathered. Maternal dietary assessment was carried out at the end of pregnancy. After delivery, blood samples were collected from 20 mother-newborn pairs. Serum levels of various lipids and leptin were analyzed. Maternal daily consumption of iron, zinc, folate were lower than the RDA of each nutrient and index of nutritional quality was less than 1 showing that the quality of maternal diet was low. The levels of serum leptin of mothers and infants were 10.2+/-6.7 ng/ ml and 1.7+/-0.6 ng/ml, respectively. The serum leptin concentrations of male infants (1.9+/-0.7 ng /ml) were not different from that of females (1.7+/-0.5 ng/ml). A negative correlation was found between the maternal pre-pregnant BMI and weight gain during pregnancy (r=-0.54, p<0.05). There was a positive correlation between the pregnancy weight gain and the newborn's birth weight (r = 0.59, p<0.01). There were also positive correlation between newborn's birth weight and newborn's serum leptin levels (r =0.57, p<0.01). No correlations were found between maternal serum leptin levels and that of newborn's. Efforts should be made to attain adequate diet and weight gain during the pregnancy to reduce the likelihood of low or over birth weight of newborns.

Simultaneous occurrence of a granulosa cell tumor and a serous cystadenoma in the same ovary: A case report / 대한산부인과학회지

This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.

Elevated Expression of p73 and Its Relation to VEGF and TSP-1 Production in Cervical Carcinoma / 대한산부인과학회지

OBJECTIVE: Measure the over-expression of p73 and analyze as the prognostic as well as angiogenic factor of cervical cancer by comparing the degree of expression of VEGF and TSP-1 by RT-PCR. METHODS: 7 normal and 37 cervical cancer specimens were put through RT-PCR and the expression of p73, VEGF and TSP-1 were measured. After immunohistochemical staining, the number of microvessels was counted. With the level of expression, investigated the relationship with the clinicopathological characteristics and the number of microvessels. RESULTS: 57% of cancer tissues showed abnormally high levels of p73 mRNA. In quantitative genomic DNA PCR, the p73 was over-expressed in the transcription level. Through allotyping with Sty I polymorphism, the over-expression of p73 was due to the transcription activity of the silent allele. In RT-PCR-SSCP analysis of over-expressed specimens, sequence alterations was not seen. In 73%, VEGF was over-expressed while TSP-1 was under-expressed in 35%. There was no association between the number of microvessels with the over-expression of p73 and VEGF, but inversely associated with the under-expression of TSP-1. There was no correlation between the over-expression of p73 and the clinicopathological characteristics. The over-expression of p73 coincided 80% with the over-expression of VEGF, and 40% with the under-expression of TSP-1. CONCLUSION: These data support the expression of p73 was increased in cervical cancer tissues and was associated with the over-expression of the VEGF but not associated with the under-expression of TSP-1. The biological and clinical significance of the over-expression of p73 should be studied further in the future.

The Follicular Fluid and Serum Concentrations of Vascular Endothelial Growth Factor in patients during IVF-ET Cycles / 대한산부인과학회지

OBJECTIVE: Several aspects of female reproduction, from folliculogenesis to corpus luteum function, are related to angiogenesis. The purpose of this study is to measure the concentrations of vascular endothelial growth factor (VEGF) in follicular fluid and serum in patients during In Vitro Fertilization-Embryo Transfer (IVF-ET) cycles. METHODS: In our prospective study, twenty-nine patients who underwent in vitro fertilization by GnRH agonist short protocol were assessed at the our infertility clinic from Aug. 2003 to July 2005. Serum VEGF and follicular fluid VEGF levels were measured in all patients at the time of oocytes retrieval. The assay technique used in this study was ELISA for serum and follicular fluid VEGF. RESULTS: Of 29 cycles, 10 cycles were pregnant (34.5%). A positive correlation existed for follicular fluid VEGF and chronologic age (r=0.428, p-value=0.021). Follicular fluid VEGF concentration showed an inverse relationship with the total number of oocytes retrieved and follicles (r=-0.493, p-value=0.007; r=-0.474, p-value=0.009). But there was no statistically significant relationship between follicular fluid VEGF concentration and serum VEGF concentration (rho=0.347). Follicular fluid VEGF concentration was significantly higher in the non-pregnant group (1468.38+/-727.33 pg/mL) compared to the pregnant group (676.48+/-542.07 pg/mL) (p-value=0.003). CONCLUSION: Our data provide some of the evidences that elevated VEGF concentrations in the follicular fluid are associated with poor conception rates in the IVF-ET cycles.

Thymidine Phosphorylase Expression in Progression of Cervical Lesions: Histological Features and Microvessel Density / 대한산부인과학회지

OBJECTIVE: The object of this study was to clarify the association of thymidine phosphorylase (TP) assessed in cancer cells and in stromal cells, with clinico-pathological factors including tumor angiogenesis and prognosis in cervical cancer. METHODS: From January 1999 to December 2001, 45 cervical tissue specimens were obtained by surgical resection in the Kyung Hee University Medical Center. The study group included 25 cases in invasive squamous cell carcinomas (SCC), 9 cases in carcinoma in situ (CIS), 7 cases in microinvasive carcinoma, 4 cases in the benign uterine diseases. They were analyzed for the cellular expression of TP and the intratumoral density of microvessels by immunohistochemistry using monoclonal antibodies to TP and factor VIII related antigen, respectively. RESULTS: Our data showed that TP expression and MVC (microvessel count) increased with histologic stage from normal, through CIS to SCC, respectively. The manifestaion of TP in the epithelium and the stroma is closely related with angiogenesis. Intraepithelial tumor revealed high expression rate of TP in the stroma, invasive cervical cancer in the epithelium, microinvasive cancer in the stroma and epithelium showing different areas of manifestation for each histologic condition, but did not show a statistically significant difference. In the case of cervical cancer, the more progressive the cancer, angiogenesis and the expression of TP increased significantly. Especially in the case of invasive cancer, stromal TP expression rate was high. CONCLUSION: These results suggest that thymidine phosphorylase might play an important role in angiogenesis, involving? cooperative epithelial and stromal expression of enzyme. Thymidine phosphorylase thus could be useful for a marker in assessing the survival rate in patients with cervical cancer.

A Case of Prenatally Diagnosed Jacobsen syndrome / 대한산부인과학회지

Jacobsen syndrome is a rare condition associated with the deletion of the long arm of chromosome 11. Though several authors reported prenatal sonographic findings of the Jacobsen syndrome, there are no common disease-specific features. The majority of affected cases were identified postnatally by chromosomal analysis of the dysmorphic or mentally retarded patients. We present a prenatal case of Jacobsen syndrome with a brief review of literature. A routine scanning in a 32-year-old primigravida at 17.3 weeks' gestation showed abnormal ultrasonographic findings consistent with increased nuchal thickening and subtle cardiac abnormalities (levorotated heart axis of greater than 60 degrees and thickened ventricular wall). The patient underwent amniocentesis, and the karyotype showed deletion of the long arm of chromosome 11, 46,XX, del (11) (q23.1q24). The fetal autopsy performed following medical termination confirmed the prenatal findings. The present case represents that the prenatal sonographic detection of the nuchal thickening and subtle cardiac abnormality should warrant a careful assessment of fetal anatomy and prompt cytogenetic analysis looking for chromosomal aberrations.

A case of myasthenia gravis aggravated and diagnosed after repeat cesaerian section / 대한산부인과학회지

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction. It may considerably affect the course of the pregnancy and cause serious compications in both the mother and the infant. Antibodies to nicotinic acetylcholine receptors are the cause of the disturbant nerve impulse transmission to muscle fibers. The clinical state at the beginning of pregnancy does not predict the occurrence of exacerbations or remissions. Each pregnancy has its effect on myasthenia gravis symptoms and does not predict the course of subsequent pregnancies. We experienced a patient received respiratory support because of poor ventilation after repeat caesarean section, but she recovered without complications soon. Two days later after operation, she complained of dysphasia, dysarthria. Then, Tensilon test and acetylcholine receptor antibody test were done. She was diagnosed as myasthenia gravis and administered pyridostigmine as therapeutic dose. We present this case with brief review of the concerned literatures.

Clinicopathologic analysis and prognosis of uterine cervical cancer / 대한산부인과학회지

OBJECTIVE: The object of this retrospective study was to evaluate the clinical characteristics and prognosis of invasive uterine cervical cancer. METHODS: 445 evaluable patients with invasive cancer of the cervix were treated at Kyung Hee Medical Center from March 1984 to March 1998. In this retrospective study, we studied the clinico-pathologic characteristics (age, FIGO stage, histologic type, nodal metastasis, and treatment modalities et al) by the review of medical records. RESULTS: 1. The age distribution among the 445 patients ranged from 27 to 90 years, mostly at 51-60 years, which occupied 26.5%. The mean age was 48.9 years. 2. The frequent number of pregnancies was 3-4 times, which occupied 33.3%. The mean number of pregnancies was 5.3 times. The frequent number of deliveries was 3-4 times, which occupied 41.7%. The mean number of deliveries was 3.2 times. 3. Subdivision of 445 cases of invasive cervical carcinoma were made according to the FIGO clinical staging: Stage Ia 77 cases (17.3%), Stage Ib 156 cases (35.0%), Stage IIa 95 cases (21.3%), and Stage IIb 52 cases (11.7%), Stage III 40 cases (9.0%), and Stage IV 25 cases (5.6%). 4. Histologically, squamous cell carcinoma comprised 91.2%, adenocarcinoma 6.6%, adenosquamous carcinoma 1.7%, and others 0.5%. 5. The types of treatment were as follows; operation 36.2%, operation with chemoradiation 13.8%, operation with radiotherapy 11.4%, operation with chemotherapy 11.0%, radiation 8.8%, chemoradiation 6.9%, and others 12.0%. 6. All the excised pelvic and para-aortic lymph nodes (LN) were histologically examined and the incidence of metastasis by clinical stage showed as follows. In Stage Ib 16.4%, 2.3%, in Stage IIa 24.5%, 3.2%, and in the stage IIb 26.7%, 6.7% respectively. The most frequently involved LN among regional pelvic LN is the obturator LN (32%) followed by the external iliac LN (29%). 7. Based on the 445 cases who were available to follow up 5 years or more after treatment, survival rates were studied and analyzed. 5 year survival rate by stage revealed 96% in stage Ia, 87.3% in stage Ib, 81.3% in stage IIa, 72% in stage IIb, 47% in stage III, and 26.4% in stage IV. CONCLUSION: FIGO stage, involvement of resection margin, and LN involvement had prognostic significance in multivariate analysis (p<0.01). However, tumor size, histologic type, depth of cervical wall invasion, and lymphovascular space invasion did not.

Two Cases of Primary Malignant Mixed Mullerian Tumor of the ovary / 대한산부인과학회지

Malignant mixed mullerian tumor of the ovary are very aggressive tumors that were usually diagnosed at an older age. They are usually at an advanced stage at the time of diagnosis, and survival after diagnosis varies by stage of disease and histological type. Despite aggressive treatment that includes surgery and chemotherapy, women with these tumors have a significantly increased risk of death giving them a very poor prognosis. The poor prognosis associated with this rare disease represents a need to new therapeutic regimens to improve patients' survival. We experienced two cases of primary malignant mixed mullerian tumor of the ovary.

Two Cases of Primary Malignant Mixed Mullerian Tumor of the ovary / 대한산부인과학회지

Malignant mixed mullerian tumor of the ovary are very aggressive tumors that were usually diagnosed at an older age. They are usually at an advanced stage at the time of diagnosis, and survival after diagnosis varies by stage of disease and histological type. Despite aggressive treatment that includes surgery and chemotherapy, women with these tumors have a significantly increased risk of death giving them a very poor prognosis. The poor prognosis associated with this rare disease represents a need to new therapeutic regimens to improve patients' survival. We experienced two cases of primary malignant mixed mullerian tumor of the ovary.

Expression of the serine protease matriptase and its inhibitor HAI-1 in epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: The purposes of this study were to examine the expression of matriptase, and its inhibitor, HAI-1, in epithelial ovarian cancer and to assign clinicopathological correlations and to discuss the matriptase/inhibitor (HAI-1) system in the context of ovarian cancer and to examine the possibility that this system might be a useful therapeutic target in this disease. METHODS: A retrospective study was performed in 51 patients with primary epithelial ovarian cancer staged over Ic who have been diagnosed and treated at Kyung Hee university medical center from Jan. 1991 to Mar. 2003. They were managed with cytoreductive surgery and chemotherapy. This study was performed in paraffin embedded blocks of primary epithelial ovarian cancer of 51 patients by means of immunohistochemistry. In addition, to validate protein expression data at the gene level, matriptase/HAI-1 mRNA expression was evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR) on frozen specimens from 10 ovarian cancers. Statistical analyses of immunohistochemistry (IHC) expression data with clinicopathological parameters and survival were then performed. RESULTS: Of 51 ovarian tumors tested, 25 (49%) and 37 (72.5%) were positive staining for matriptase and HAI-1 by IHC, respectively. Of 18 stage I/II tumors, 11 (61.1%) stained positive for matriptase, and 15 (83.3%) stained positive for HAI-1; Of 18 stage I/II tumors, 10 (55.6%) tumors showed coexpression. Of 33 stage III/IV tumors, 14 (42.4%) stained positive for matriptase and 22 (66.7%) stained positive for HAI-1; Of 33 stage III/IV tumors, 11 (33.3%) tumors showed coexpression. CONCLUSION: No relationship was found between the expression of either matriptase or HAI-1 with clinicopathological parameters and survival. However, stage I/II ovarian tumors are more likely to express matriptase and HAI-1 than are the more advanced disease stage III/IV tumors. Correspondingly, the low frequency of matriptase and HAI-1 coexpression is more likely to be associated with stage III/IV tumors than stage I/II tumors. Such an imbalance in the matriptase: HAI-1 ratio could promote the proteolytic activity of matriptase and, consequently, a more invasive phenotype in the advanced tumors.

Two Cases of the Uterine Torsion at Term Pregnancy / 대한산부인과학회지

Torsion of pregnant uterus is defined as rotation of more than 45 degrees about the long axis of the uterus. Double or bicornuate uterine malformation is common cause of uterine torsion in animal group. Torsion of the human pregnant uterus especially at full term, is very rare. The reason for the occurrence of uterine torsion during pregnancy is not known, but abnormal fetal presentations, uterine myoma, and other uterine anomalies are known to be more frequent in patients with uterine torsion; maternal age, parity, and gestational age seem to play no apparent role. Symptoms of torsion of the pregnant uterus include disclosing of the cervix, abdominal tenderness, vaginal bleeding, shock, urinary symptoms and intestinal complaints. As uterine torsion may be fatal to both the fetus and the mother, promptness of the diagnosis and subsequent emergency laparotomy are essential. In this report, the authors present two cases of torsion at full-term pregnant uterus with unilateral renal agenesis, double uterus, and a transverse fetal presentation with a brief review of the literature.

A Case of Endometrial Cancer with Hereditary Non-Polyposis Colorectal Cancer (HNPCC) / 대한산부인과학회지

Endometrial cancer is the most common malignant disorder that can be associated with hereditary non-polyposis colorectal cancer (HNPCC), which is known as Lynch II syndrome. HNPCC is a polyposis of the colon which is inherited in an autosomal dominant pattern and can cause cancer in other organs, especially in the endometrium. The overall risk of a women with HNPCC to develop endometrial cancer is 40-60%, much higher than the 3% of the general population of women. The average age of developing endometrial cancer of a women with HNPCC is 45 years of age and is often found before development of colon cancer. We have recently experienced a case of de novo type of hereditary non-polyposis colorectal cancer associated with endometrial cancer, hence we are reporting this case with a brief review of literatures.

Clinical Analysis of The Invasive Cervical Cancer Patients Treated by Radical Hysterectomy / 대한산부인과학회지

OBJECTIVE: This study was undertaken to analyze the demographic profile and clinicopathologic characteristics of the patients with invasive cervical cancer who had undergone radical hysterectomy. METHODS: Records of 285 patients with invasive cervical cancer who had undergone radical hysterectomy and pelvic lymph node dissection at Kyung Hee University Hospital from January 1986 to March 2001 were reviewed retrospectively. In this study, we analyzed the clinicopathologic characteristics such as age, FIGO stage, histologic type, nodal metastasis, treatment modalities, complications, recurrence rates, and the overall 5-year survival rates et al. by using univariate anaysis and Kaplan-Meier method. RESULTS AND CONCLUSION: Ages ranged from 28 to 78. The mean age was 50.6. The number of patients of 285 being in FIGO stage Ia was 34 (11.9%), Ib 146 (51.2%), IIa 78 (27.4%), IIb 27 (9.5%). In the distribution of histological type, the number of squamous cell carcinoma was 258 (90.5%), adenocarcinoma 20 (7.0%), adenosquamous carcinoma 7 (2.5%). LN involvement was present in 5.9% with stage Ia, 16.4% with Ib, 24.4% with IIa, 25.9% with IIb. Obturator LN was the most frequently involved among pelvic lymph node. Urinary tract infection was the most common complication after surgery, occupying 15.1%. 26 cases (9.1%) developed recurrence. The recurrence rate was 0% in stage Ia, 8.2% in stage Ib, 11.5% in stage IIa, 18.5% in stage IIb. The overall 5-year survival rate was 100% in stage Ia, 89.4% in stage Ib, 80.0% in stage IIa and 72.2% in stage IIb. FIGO stage, tumor mass size, resection margin, lymph node involvement had a statistical prognostic significance (P<0.01).

Correlation of the Expression of COX-2 and VEGF in Cervical Squamous Cell Carcinomas / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to know the potential of growth, invasion and metastasis of uterine cervical cancer associated with neovascularization and to investigate whether the enhanced COX-2 (Cyclooxygenase-2) and VEGF (Vascular Endothelial Growth Factor) expression is showed through CIS to invasive cervical cancer and to examine that COX-2 and VEGF expressions are associated with prognostically worse pathological variables and had a direct correlation with tumor MVD (microvessel density). METHODS: From January 1999 to December 2001, 45 paraffin-embedded cervical specimens were obtained by surgical resection in the Kyung Hee University Medical Center. The study group included 25 cases in invasive squamous carcinomas, 7 cases in microinvasive carcinoma, 9 cases in carcinoma in situ, 4 cases in the benign uterine diseases. All tissues were subjected to immunohistochemical staining for COX-2, VEGF and microvessel density (MVD), and immunostaining was scored using a four-point scale with (0) indicating no expression, (1) light staining, (2) moderate staining, (3) heavy staining. RESULTS: As the cervical tumorigenesis progressed, there was a significant increase of MVC (microvessel count) and COX-2 expression. There is a significant correlation between COX-2 and VEGF expression (r(s)=0.686, p<0.01) in cervical neoplasms. There was no correlation between COX-2, VEGF expression and clinicopathologic factors in cervical caner. CONCLUSION: These findings provide evidence that the expression of COX-2 and VEGF is involved in the promotion of angiogenesis in cervical neoplasms and plays an important role in early invasion.

The Effect on Pain of Waiting between Paracervical Block and Procedure in Dilatation and Curettage / 대한산부인과학회잡지

OBJECTIVE: In Korea, approximately 600 thousand artificial abortions are done officially during the course of a year, and dilatation and curettage is commonly used as a method for selective abortion. In addition, because of the increasing use of hormone replacement therapy for treating postmenopausal syndrome and for the diagnostic purposes for postmenopausal bleeding, the importance of dilatation and curettage is emphasized more and more. Our objective was to verify the effects of delayed time between paracervical block and the procedure of dilatation and curettage on pain and patient satisfaction. METHODS: 92 women who underwent dilatation and curettage were picked and divided into 2 groups randomly. In group A there was no transit delay time between paracervical block and the procedure, and in group B, there was 5 minutes delay time. We used the VAS (Visual Analogue Scale) to measure numerical value of pain and patient satisfaction during uterine cervical dilatation, the actual procedure of curettage, and 30-45 minutes after the procedure. RESULTS: There was no statistically meaningful difference on the pain value and patient satisfaction between group A and group B measured during uterine cervix dilatation, curettage, and 30-45 minutes after the procedure. CONCLUSION: The transit delay time between paracervial anesthesia and dilatation and curettage had no specific effects on the pain or patient satisfaction of the procedure. Therefore, the main role of paracervical anesthesia is not to block the peripheral nerve, but instead to dilatate the tissue mechanically.

The Effects of Soy Milk Supplement on Isoflavone Concentration of Breast Milk, Plasma and Urine from Breast Feeding Woman

Soybeans have been a major protein source for many centuries in Korea. Soybeans contain phytochemicals which are isoflavones, biochemically active component. Isoflavone is a kind of phytoestrogen, structurally and functionally similar to estrogen. It has been reported that the breast milk and blood of breast feeding mothers who consume soy products contain isoflavones. This study was conducted to investigate the effects of soy milk supplement on the isoflavones (daidzein, genistein) concentration of breast milk, plasma and urine from breast feeding woman. Seventeen healthy women who delivered at Kyung Hee Medical Center were recruited. For the first 2 weeks after delivery, seventeen women ingested 400 ml (isoflavone 43.2 mg) of soy milk on the given time starting from the day of giving birth. For the next 2 weeks, soy milk ingestion was withdrawn. Dietary intake and anthropometric data were checked and breast milk, blood, and 24 hr urine samples were collected on the day of giving birth, the 14th (the last day of the supplement phase) and 28th (the last day of the withdrawal phase) day, respectively. HPLC analysis was used to measure the concentration of isoflavones. Dietary intakes of the subjects were inadequate for the Korean RDA regardless of soy milk supplementation. Especially, intakes of vit A, calcium, and iron were very low. The Anthropometric data such as LBM, TBW, PIBW, BMI checked on the day of 14th decreased and maintained their levels by the 28th day. Daidzein concentration in breast milk was not affected by soy milk supplementation. However, genistein concentration decreased by the 28th day (14th day: 0.89 +/- 0.10 microgram/ml, 28th day : 0.48 +/- 0.07 microgram/ml) (p<0.05). Plasma daidzein and genistein concentrations were not changed by the 14th day and decreased by the 28th day (14th day: 49.64 +/- 3.30 ng/ml, 26.72 +/- 2.90 ng/ml, 28th day: 38.30 +/- 4.40 ng/ml, 6.51 +/- 0.50 ng/ml, respectively) (p<0.05). Twenty four hour urine concentrations of daidzein and genistein significantly increased by the 14th day and decreased by the 28th day (14th day: 5.80 :t 0.3 mg/d, 4.17 +/- 0.2 mg/d, 28th day: 6.72 +/- 0.4 mg/d, 5.09 +/- 0.5 mg/d, respectively) (p<0.001). The rate of urinary recovery of daidzein was greater than that of genistein. The results of this study indicate that the supplement of dietary soy milk to the lactating women elevates the contents of isoflavone in the breast milk.

A Case of Primary Abdominal Pregnancy with Intraperitoneal Hemorrhage / 대한산부인과학회잡지

Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studifford criteria. The clinical characteristics of abdominal pregnancy is extremely variable, so early diagnosis is very difficult. Because of it's high maternal morbidity and mortality, the prompt surgical intervention is required. We experienced a primary abdominal pregnancy with intraperitoneal hemorrhage. So we present our case with a brief review of literature.