Modern Approach to Treating Mental Patients in Colonial Chosun / 의사학

Literature produced by the government and the private sector in the colonial era was reviewed to determine the knowledge of the people of colonial Chosun of mental illness and mental patients and the mental patient management system that they implemented or intended to implement. The results of this study show that the people of Chosun realized the need to sterilize mental patients because they considered mental patients very violent, dangerous and eugenically inferior and they believed that mental patients would eventually impede the prosperity of Chosun. The people of colonial Chosun had learned about the lifelong mental hygiene movement, which had knowledge of mental illness prevention. However, they also recognized that people who developed mental illness despite efforts to prevent such condition needed help from the modern system, especially from modern Western psychiatry. The primary responsibility to attend to mental patients was imposed on their family. The family had to understand the symptoms of mental illness according to the modern medical classification and how to deal with them. When the family could not afford to take care of its mentally ill family member due to the increase in the member's risk behavior such as frenzied-convulsive excitement, paranoia and delusion of jealousy, the family was also responsible for isolating him and connecting him with a mental hospital. The police and social workers were also responsible for observing and monitoring mental patients in their community and for connecting them with a mental hospital. The police made a list of mental patients within their area of jurisdiction and prohibited them from wandering based on the law. It was also considered desirable for mental patients who could not identify their family members to be sent to a mental hospital. Social workers were responsible for managing mental patient sanatoriums, and district commissioners sent to the police mental patients who had no family to look after them or who posed a threat to others, or else commissioned them to the government hospital. Thus, the final responsibility for mental patients was imposed on the modern Western medical team, because the district commissioners sent them to the police and the police sent them to the government mental hospital. Most educated people and government personnel in the colonial era thought modern Western psychiatry circles were responsible for mental patient management, and the Japanese empire enacted mental-health-related laws and made efforts to secure funds for the establishment of mental hospitals. As the literature at that time also show the position of the modern Western medical circle, their ambivalent attitude to mental patients must also be clarified to interpret the modern approach to treating mental patients in colonial Chosun. In this context, a research on historical figures in Japanese psychiatry, a study on the specific treatment methods used by the modern Western psychiatric team in the colonial era and their effects, and the extension of the subject period for such researches are suggested.

Comparison of IVF-ET Outcome after Various Therapeutic Approaches for Ovarian Endometriomas / 대한불임학회지

OBJECTIVE: To compare COH characteristics and IVF outcomes among IVF-ET patients who were treated with various therapeutic modalities for ovarian endometriomas and to propose effective pre-cyclic therapeutic modalities to improve IVF-ET outcomes in the patients with ovarian endometriomas. METHODS: All cases that had undergone IVF-ET after laparoscopy between January 1997 to August 2003 were reviewed. Forty-eight patients with tubal factor were assigned to Group I. Twenty seven, 22 and 38 patients diagnosed as severe pelvic adhesion with ovarian endometriomas by laparoscopy received only medical therapy (Group II), cyst aspiration (Group III), and sclerotherapy (Group IV), respectively. Laparoscopic cystectomy was performed in 20 patients (Group V). Resistance index was measured on day administering hCG. RESULTS: As compared with Group I, in Group II resistance index increased (p<0.05) but number of oocytes, good-quality oocyte ratio (mature and intermediate oocytes/total retrieval oocytes), fertilization rate, and embryo development rate decreased (p<0.05). In Group III fertilization rate and embryo development rate decreased (p<0.05). There was no difference between Group IV and Group I in all parameters except basal FSH which increased (p<0.05). In Group V basal FSH, and resistance increased (p<0.05) and number of oocytes and good-quality oocytes ratio decreased (p<0.05). CONCLUSION: Sclerotherapy is an effective therapeutic option which can be done prior to IVF-ET cycles in the patients with ovarian endometriomas. Further studies on a large scale are necessary to confirm these data.

Identification of High Risk Group of HPV associated with Cervical Cancer in Korean Women / 대한산부인과학회잡지

OBJECTIVE: To identify genital HPV types and high risk group of HPV associated with cervical cancer in Korean women. METHODS: Both Pap test and HPV-DNA test using PCR assay were performed as screening test for cervical cancer in this clinic. When patients were positive in HPV-DNA test, HPV genotyping using sequencing method and cervical biopsy were performed. RESULTS: Frequent age group of HPV infection was 40 yrs (34.3%) and prevalence of HPV infection was 9.8%. Twenty-three types of HPV were detected. HPV 16 and 58 were detected in invasive cancer. HPV 16, 31, 33, 45, and 58 were detected in HSIL. HPV 6, 11, 18, 53, 59, and 66 were detected in LSIL. HPV 16 was most commonly detected in HSIL and invasive cancer. CONCLUSION: HPV 16, 31, 33, 45, and 58 are included in high risk group of HPV in Korean women. It may be very effective in early detection of cervical cancer to classify HPV types included in high risk group of cervical cancer in Korean women and to perform cervical biopsy in the patients who have high risk types of HPV infection.

Identification of High Risk Group of HPV associated with Cervical Cancer in Korean Women / 대한산부인과학회잡지

OBJECTIVE: To identify genital HPV types and high risk group of HPV associated with cervical cancer in Korean women. METHODS: Both Pap test and HPV-DNA test using PCR assay were performed as screening test for cervical cancer in this clinic. When patients were positive in HPV-DNA test, HPV genotyping using sequencing method and cervical biopsy were performed. RESULTS: Frequent age group of HPV infection was 40 yrs (34.3%) and prevalence of HPV infection was 9.8%. Twenty-three types of HPV were detected. HPV 16 and 58 were detected in invasive cancer. HPV 16, 31, 33, 45, and 58 were detected in HSIL. HPV 6, 11, 18, 53, 59, and 66 were detected in LSIL. HPV 16 was most commonly detected in HSIL and invasive cancer. CONCLUSION: HPV 16, 31, 33, 45, and 58 are included in high risk group of HPV in Korean women. It may be very effective in early detection of cervical cancer to classify HPV types included in high risk group of cervical cancer in Korean women and to perform cervical biopsy in the patients who have high risk types of HPV infection.

GnRH Antagonist Multiple Dose Protocol in Controlled Ovarian Hyperstimulation for In Vitro Fertilization and Embryo Transfer Compared with GnRH Agonist Long Protocol / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of GnRH antagonist multiple dose protocol (MDP) in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) comparing with the standard GnRH agonist long protocol (GnRH-a LP). METHODS: From January 2000 to September 2002, 57 infertile women with tubal factor alone who had undergone IVF-ET were enrolled in the present study. Study group consisted of 28 patients in 28 cycles in which GnRH antagonist Cetrorelix 0.25 mg was given daily when the leading follicle reached 14 mm in mean diameter until the human chorionic gonadotropin (hCG) injection. Control group consisted of 29 patients in 29 cycles in which COH was performed using standard GnRH-a luteal LP. RESULTS: Patient's characteristics were comparable in both groups. Premature luteinization was not developed in all patients in each group. The number of ampules and duration of exogenous gonadotropins required were significantly lower in the study group than those in the control group (por=14 mm diameter on the day of hCG injection, the number of oocytes retrieved, fertilization rate, and the number of grade I, II embryos between the two groups, but the numbers of mature oocytes retrieved and fertilized oocytes were significantly lower in the study group than in the control group (p<0.01, p<0.01). The clinical pregnancy rate seemed to be lower in the study group, but the difference did not achieve significance (28.6% vs 34.5%). There were also no differences in the miscarriage rate and multiple pregnancy rate between the two groups. CONCLUSION: This study demonstrates that GnRH antagonist Cetrorelix MDP can result in the comparable pregnancy outcome as the GnRH-a LP and furthermore reduce the total dose of gonadotropins and duration of stimulation.

Clinical Experience with Leuprorelin Acetate in the Treatment of Endometriosis / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical efficacy and safety of Lorelin(R), a depot form of leuprorelin acetate made in Korea, in the treatment of endometriosis. MATERIALS AND METHODS: Twenty patients with surgically proven endometriosis were recruited and followed during about 21 weeks of treatment. Lorelin(R) 3.75 mg was injected every 4 weeks after the first injection following initial operation and a total of six doses were injected to a patient. Symptom severity score, chemical battery, lipid battery, and serum levels of follicule stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and CA-l25 were assayed before Lorelin(R) treatment, after 3 doses, and after 6 doses. Statistical analysis was performed utilizing repeated analysis of variance (ANOVA) and results with P-value less than 0.05 were considered significant. RESULTS: The age range at initial operation was 25 to 48 and the mean age was 36.5+/-6.1 (mean+/-SD) years. Symptom severity score and serum levels of LH, FSH, E2, and CA-125 were significantly lower after 3 and 6 doses of Lorelin(R) than before treatment. Transient elevation of liver enzyme was observed in 2 patients after 3 doses of Lorelin(R). Side effects were mainly due to treatment-induced hypoestrogenism and the most frequent symptom was hot flush (55%), vaginal dryness (30%), transient nausea sense (25%), and arthralgia (25%). All patients were able to tolerate these symptoms and no one discontinued Lorelin(R) therapy. CONCLUSION: This study suggests that Lorelin(R) could be an effective and safe regimen in the treatment of endometriosis.

Influence of Activin and Follistatin on Expression of Insulin-like Growth Factor (IGF)-I, II, Insulin-like Growth Factor Binding Protein (IGFBP)-1, 2, and 3 mRNA in Cultured Mouse Granulosa Cells / 대한산부인과학회잡지

OBJECTIVE: To investigate the influence of activin and follistatin on the expression of IGF (insulin-like growth factor)-I, II, IGFBP (insulin-like growth factor binding protein)-1, 2, and 3 mRNA in cultured mouse granulosa cells MATERIALS AND METHODS: The granulosa cells were obtained from the mouse and cultured for 6 days with 10 ng/ml of activin, 10 ng/ml of follistatin, and 10 ng/ml of activin with 10 ng/m of follistatin, respectively. The cells not treated with activin or follistatin served as control. Reverse transcription-polymerase chain reaction (RT-PCR) has been used to examine the expression of IGF-I, II, IGFBP-1, 2, and 3 mRNA. Results were analyzed with Kolmogorov-Smirnov test and analysis of variance (ANOVA) and statistical significance was defined as p<0.05. RESULTS: The expression of IGF-I and II mRNA were not different significantly. However, the expression of IGFBP-3 mRNA was significantly increased in the follistatin group compared to the control group (p<0.05) and significantly decreased in the activin with follistatin group compared to the control group (p<0.05). The expression of IGFBP-1 mRNA was seemed to be increased in the activin group and decreased in the follistatin group compared to the control group, respectively (p=0.07, p=0.07). The expression of IGFBP-2 and 3 mRNA were seemed to be decreased in the activin group compared to the control group (p=0.06, p=0.07, respectively). CONCLUSION: Activin and follistatin might play a role as regulators of mouse ovarian physiology by modulating the IGF system, especially IGFBPs.

Panhypopituitarism in a Pregnant Woman with Ovarian Hyperstimulation Syndrome and Residual Pituitary Adenoma / 대한산부인과학회잡지

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian hyperstimulation (COH) and ovulation induction. High serum estradiol concentration can induce the increase of capillary permeability and fluid shift, and it can results in hypovolemia, hemoconcetration, thromboembolism, oliguria, ascites and even death. This physiologic changes of OHSS and/or pregnancy might induce the deterioration of pituitary function in patients with abnormal pituitary conditions such as low pituitary reserve or tumor. However, all this while, panhypopituitarism or pituitary apoplexy in a pregnant woman with OHSS and/or pituitary adenoma has not been reported. We have experienced a case of panhypopituitarism developed in a pregnant woman with severe OHSS and residual pituitary adenoma. She had residual prolactinoma, despite a transsphenoidal adenoidectomy, and had suffered from uncontrolled hyperprolactinemia (HPRL) and chronic anovulation. Therefore, she had taken ovulation induction for getting a pregnancy and conceived, but, in the conception cycle, she was hospitalized for management of severe OHSS and hyperemesis gravidarum. During the period of hospitalization, abrupt panhypopituitarism was developed unexpectedly. Therefore, we present this case with the brief review of literature.

The Predictive Value of a Single Serum Beta Human Chorionic Gonadotropin Level in Pregnancies Achieved by Intrauterine Insemination and In Vitro Fertilization-Embryo Transfer Program / 대한산부인과학회잡지

OBJECTIVE: To clarify specific serum beta-human chorionic gonadotropin (beta-hCG) levels on 11 days after intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET) that could predict live birth. METHODS: Three hundred ninety-two pregnancies resulting from IUI and IVF-ET procedures between January 1, 1997 and December 31, 2000 were evaluated. Serum quantitative beta-hCG levels were measured 11 days after IUI or ET using standard immunoradiometric assays. Pregnancy outcomes were categorized as spontaneous abortion, biochemical pregnancy, ectopic pregnancy, singleton live birth, or multiple live birth. Statistical analyses were performed by analysis of variances, and Student's t-test. The sensitivity and specificity of serum beta-hCG level for predicting live birth were plotted using receiver-operator-characteristic (ROC) curve. RESULTS: The multiple live birth group has significantly higher serum beta-hCG level among the different pregnancy outcome groups. The beta-hCG level on the eleventh day after IUI and IVF-ET was significantly higher in the live birth group than the non viable pregnancy group. At a threshold level of 65 mIU/ml, the serum beta-hCG level on the eleventh day after IUI had a positive predictive value of 78.9% in predicting live birth with 95% specificity. At a threshold level of 115 mIU/ml, the serum beta human chorionic gonadotropin level on the eleventh day after ET had a positive predictive value of 92.1% with 95% specificity. CONCLUSION: These data suggest that serum beta-hCG level on 11 days after IVF-ET could be a reliable indicator predicting pregnancy outcome.

Expression of Epidermal Growth Factor, Transforming Growth Factor-alpha and Epidermal Growth Factor Receptor in Human Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: This study seeks to define the expression of epidermal growth factor(EGF) and transforming growth factor(TGF)-alpha and epidermal growth factor receptor(EGFR), and the relationship to the tumor progression of human cervical epithelial neoplasia. METHODS: To confirm the expression of EGF, TGF-alpha and EGFR immunohistochemically in normal cervix, cervical intraepithelial neoplasms and cervical carcinomas, we used monoclonal antibodies to EGF, TGF-alpha and EGFR. RESULTS: Immunohistochemical stainings using anti-EGF, anti-TGF-alpha and anti-EGFR antibodies showed weak or moderate stainings in all cases. Normal and CIN cases showed predominantly basal and parabasal expression of EGF, TGF-alpha and EGFR, and its expression decreased as the cells became increasingly differentiated toward the surface of the epithelium. In the cervical carcinoma EGF and TGF-alpha expressed weakly to moderately focally, and EGFR expressed intensely in all malignant cells. CONCLUSION: These results suggest that EGF, TGF-alpha and EGFR may involved in cellular proliferation of cervical squamous epithelium and have a significant role in the progression of cervical cancer.

A Clinical Study of Ectopic Pregnancy during Recent 5 years / 대한산부인과학회잡지

OBJECTIVE: The incidence of ectopic pregnancy is increasing recently. To establish the quick and accurate diagnosis of ectopic pregnancy, we reviewed and analyzed the cases during recent 5 years. METHODS: Study datas was acquired from the 448 cases of the ectopic pregnancies who were managed and confirmed histopathologically at the our hospital from Jan. 1 1995 to Dec. 31 1999. RESULTS: The incidence of ectopic pregnancy was 1 in 20 deliveries. The most common age group was 26-30 years of age(34.4%). A previous history of abdominal or pelvic surgery was in 42.1% and tubal sterilization was in 14.1%, pelvic inflammatory disease was in 8.3%. Hemoglobin value over 10.0 gm/dl was in 79.2% and below 8.0 gm/dl in 4.5%. Initial systolic blood pressure risen above 100mmHg was in 79.0%. The most frequent intervals between last menstrual period and the onset of symptom was 6~8 weeks in 56.0%. The clinical manifestations were appeared in 78.8% from the last menstrual period to the next 4~8 weeks. In clinical symptoms, amenorrhea was encountered in 91.7%, lower abdominal pain in 88.3% and vaginal spotting in 47.3%. Ectopic gestation was implanted on the fallopian tube in 97.1%, the ovary in 1.1%, the cervix in 0.7%, the intraabdominal in 0.9% and 1 case was intramural pregnancy. Total amount of intraperitoneal hemorrhage between 100-999ml was in 59.5%, above 1,000ml in 37.5% and less than 100 ml in 3.0%. Of total 448 cases, laparotomy was done in 229 cases(51.0%) and pelvisopic surgery in 219 cases(49.0%). The mean hospital stay was 3.1 days in pelviscopy procedure and 5.0 days in laparotomy. The operative precedures were salpingectomy in 87.5%, salpingo-oophorectomy in 4.9%, cornual resection in 6.3%, ovarian wedge resection in 0.7%, and oophorectomy in 0.2%. There was no dead case in all ectopic pregnancy. Average admission period after laparoscopy was 3.1 day and after laparotomy was 5.0 day. CONCLUSION: The cognizing of increasing incidence of ectopic pregnancy, early diagnosis and early treatment is presumed to decrease mortality and increase fertility. The successful treatment and decision is a challenge to the clinician who must consider the patient's needs with appropriate tactfulness.

Influence of prostaglandin E2 and prostacyclin on vascular endothelial growth factor and basic fibroblast growth factor expression in cultured human trophoblast / 대한산부인과학회잡지

BACKGRUOND: Several angiogenic factors such as bFGF and VEGF have been shown angiogenesis of placenta. PGE2 and PGI2 may be important in successful establishment of pregnancy. OBJECTIVE: We studied to investigate whether PGE2 and PGI2 regulate expression of VEGF and bFGF gene in the cultured human trophoblast cells. METHODS: Human trophoblasts were isolated from the placenta of early gestation (6-12 weeks). Isolated trophoblasts were cultured in the different concentration of PGE2 and PGI2 and according to the different cultured time of PGE2 and PGI2, respectively. Total RNA was extracted and RT-PCR was performed. RESULT: Expression of bFGF was increased in 10-7M and 10-6M of PGE2 and was always increased in the all different concentration of PGI2. Four isoforms (VEGF121, VEGF165, VEGF189, VEGF206) were always expressed in the all different PGE2 and PGI2 concentration compared to the control group. However, there was no significant difference in the all different PGE2 and PGI2 concentration. In both PGE2 and PGI2 treatment group, expression of bFGF was decreased at 60 min compared to the control group and was gradually increased in time-dependent pattern. At 180 min, its expression was similar to the control group. CONCLUSION: Our data suggest that the expression of bFGF gene is influenced by cultured time and concentration of PGE2 and PGI2, although the expression of VEGF gene is not influenced.