A case of placenta previa percreta with bladder invasion / 대한산부인과학회잡지

Placenta percreta with bladder invasion is an extremely rare complication causing life-threatening hemorrhage, up to 17 liters.1 Most reported cases have been diagnosed after 30 weeks of pregnancy and few have presented before 20 weeks.2 Only 20 cases of placenta percreta with invasion of the bladder have been reported during last decade. In this condition, chorionic villi attach directly to the myometrium without intervening decidua. The exact etiology of impaired decidualization is unknown; however, a previous endometrial insult, such as previous cesarian section or endometrial curettage may be a contributing factor. To avoid massive bleeding, uterine body incision, hypogastric artery ligation before hysterectomy and uterine cervical removal have been attempted.1 Chorionic villi may attach to the myometrium (accreta), invade the myometrium(increta), or in its severe form (percreta) the trophoblastic tissue penetrates the whole myometrium and invades adjacent structures. We experienced a case of placenta previa percreta with bladder invasion and review the literatures.

The Study of the Change in the Oxidative System Balance in Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: This study assesses the hypothesis that preeclampsia is associated with the change of oxidative system balance by measuring the lipid peroxidation and antioxidant activity in preeclampsia. METHOD: Venous blood samples were collected from twenty women with preeclampsia and twenty women with uncomplicated pregnancies. Total lipid peroxidation, total antioxidant activity, antioxidant enzyme activity and antioxidant concentration were measured using flow injection-chemiluminescent method. RESULTS: 1. Total lipid peroxidation(PCOOH) was higher in preeclampsia(717.22+/-93.08 pmol/ml) than in normal pregnant(486.86+/-43.15 pmol/ml) (P<0.05). 2. Total antioxidant activity was significantly higher in preeclampsia(46.02+/-5.95 % inhibition) than in normal pregnant(38.59+/-7.57 % inhibition) (P<0.05).3. Antioxidant enzyme, catalase activity in RBC was lower in preeclampsia(346.59+/-82.84 unit/gHb) than in normal pregnant(440.62+/-72.8 unit/gHb) (P<0.05).4. Antioxidant, alpha-tocopherol concentration in RBC was slightly lower in preeclampsia(33.21+/-7.82 ng/gHb) than in normal pregnant(36.06+/-6.86 ng/gH), but there was no statistically significant difference (P<0.05). CONCLUSION: This data seems to show that preeclampsia is associated with an imbalance between the lipid peroxidation and the antioxidant system.

Clinical value of pretreatment serum cyfra 21-1 and SCC Ag levels in cervical cancer patients / 대한산부인과학회잡지

OBJECTIVES: SCC Ag(Squamous cell carcinoma antigen) is so far the most useful tumor marker in assisting clinical diagnosis of cervical cancer and follow-up after therapy. Elevated levels of cytokeratin 19-fragments(CYFRA 21-1) have recently been detected in large proportion of patients with non small cell cancer of the lung, and in particular those with squamous cell carcinoma. This study is to assess the clinical efficacy of CYFRA 21-1 with SCC Ag as the clinicopathologic parameter in cervical cancer. METHOD: Retrospective analysis of the serum tumor markers CYFRA 21-1 & SCC Ag in eighty cervical cancer patients was performed. RESULTS: Cut off values for SCC Ag & CYFRA 21-1 were 1.94 ng/ml, 3.11 ng/ml respectively. Using the cut-off point, the sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) of serum SCC were 55, 95, 97, 46%, respectively. Serum CYFRA 21-1 showed a sensitivity of 45%, specificity of 91%, PPV of 87%, and NPV of 55%. The combination of SCC and CYFRA 21-1 increased the sensitivity to 62%, with a specificity, PPV, and NPV of 72, 75, 58%. Serum levels of both markers were compared with tumor stage, lesion size and were significantly related. In FIGO stage Ib-IIa, the serum levels of SCC Ag & CYFRA were 2.2+/-3.9, 2.5+/-3.6 ng/ml and in FIGO stage IIb-IV, 12.2+/-15.2, 10.8+/-11.2 ng/ml. In 4cm of lesion size, 11.8+/-11.9, 7.7+/-9.3 ng/ml. CONCLUSION: These data seems to show that serum CYFRA 21-1 may be of additional value in assessing the state of disease in some patients with cervical cancer. The prediction of recurrent cervical cancer with SCC Ag were improved by the combination with CYFRA 21-1 but further investigation is needed.

The Detection of Oxygen Free Fadical Scavenger, Superoxide Dismutase(SOD) on the Uterine Cervical Tissue / 대한부인종양콜포스코피학회잡지

The superoxide anion, hydrogen peroxide, and hydroxyl radical are oxygen free radicals which arise in cell metabolism and which are toxic to cells, with an important role in carcinogenesis. The measurement of the oxygen free radical is a problem due to the instantaneously changing nature, and therefore the superoxide dismutase(SOD) is employed which act as an oxygen free radical scavenger. The authors quantitatively analyzed the SOD levels in normal uterine cervix epithelium, cervical intraepithelial neoplasia, and in invasive cervical cancer patients by the SOD-525R spectrophotometric assay and compared the results between each group with respect to prognostic variables such as stage of disease, cell type, lymph node involvement, and SCC Ag(TA-4 Ag) levels. The mean SOD levels were 0.41U/ml, 0.39U/ml and 0.73U/ml in the normal uterine cervix, intraepithelial neoplasia, and invasive cervical cancer groups, respectively, showing statistically significant difference by the Oneway anova test(p=0.05). The mean SOD levels according to the stage of disease were 0.5U/ml, 0.62U/ml, and 1. 15U/ml for stages I a, I b, and stage II and above(p=0.029). For the cell type the SOD levels were 0.77/ml for squamous cell carcinoma and 0.57U/ml for adenocarcinoma(p=0.15). For cancer cell lymph node involvement cases, the mean SOD levels were 0.75U/ml and 0.57U/ml for lymph node involvement and no involvement respectively(p=NS). The mean SOD levels also did not show any significance when compared with SCC Ag levels where SOD was 0.78U/ml for SCC Ag levels of more than 2.0ng/ml, and 0.77U/ml for SCC Ag levels of less than 2.0ng/ml. From the above results the authors conclude that SOD levels were higher in invasive cervical cancer tissues compared to intraepithelial neoplasia and normal cervical tissues, that SOD levels increased with higher stage of disease, and that there was no relationship between SOD levels and known prognostic variables such as cell type, lymph node involvement and SCC Ag level.

A Case of Invasive Mole Initially Presenting with Symptoms of Brain Metastasis / 대한부인종양콜포스코피학회잡지

Invasive mole is a malignant form of hydatidiform mole and can be seen occasionally. It invades the myometrium, adjacent structures and metastasizes distantly. It can initially appear with symptoms of the respiratory, genitourinary system, or rarely intraperitoneal hemorrhage. However, reports of invasive mole initially presenting symptom of brain metastasis is rare and is occasionally found at autopsy. We report a case of invasive mole which had metastasized to the brain and lung and initially presented with symptoms of brain metastasis.