Is WHODAS 2.0 Useful for Colorectal Cancer Survivors?

OBJECTIVE: To compare the disability level of colorectal cancer survivors with and without stoma by using the Korean version of the 12-item, interview-administered World Health Organization Disability Assessment Schedule 2.0 (Korean version of WHODAS 2.0). METHODS: This is a multicenter (five tertiary university hospitals and the Korea Ostomy Association) and cross-sectional survey. Colorectal cancer survivors with and without stoma were interviewed. Survey measured disability level using the Korean version of WHODAS 2.0 and health-related quality of life using the SF-36. RESULTS: A significant difference was observed between patients with and without a stoma in two subdomains: getting around (31.1 vs. 20.3; p=0.013) and participation in society (32.3 vs. 22.2; p=0.028). After adjusting for age, gender, and time since surgery, having a stoma was associated with severe to extreme disabilities in participation (OR=2.72, p=0.045). The Korean version of WHODAS 2.0 showed satisfactory internal consistency (r=0.96) and convergent validity. CONCLUSION: Patients with stoma participated less in society than those without stoma. The Korean version of WHODAS 2.0 is a reliable and valid instrument for measuring disability in Korean colorectal cancer patients.

Disability Identity According to the Severity of Disabilities in Persons with Spinal Cord Injury

OBJECTIVE: To investigate the disability identity and life satisfaction according to the severity of disability in the spinal cord injured persons resident in the community. METHOD: The subjects of this national wide study were 397 spinal cord injured persons resident in the community. We investigated their disability identity, life satisfaction, depression, social integration and social support. The questionnaire included the newly developed disability identity scale to evaluate the disability identity, that consisted of five sub-scales (personal worth, self-acceptance with the disabled, individual civil right, common cause and external barriers) and 23 questions. The subjects were divided into four groups according to severity of disability: motor complete tetraplegia, motor incomplete tetraplegia, motor complete paraplegia and motor incomplete paraplegia. RESULTS: The scores of life satisfaction, depression and social support were not different according the four groups. However the disability identity scale of the motor incomplete paraplegia was lower than motor complete tetraplegia or motor complete paraplegia (p<0.05). The sub-scale score of the personal worth and self-acceptance were lower in less severely disabled persons. As the disability identity scale was higher, social integration (r=0.478, p=0.000), and social support (r=0.465, p=0.000) were moderate and the depression was negative (r=-0.252, p=0.000). Conclusion: Less severely disabled persons showed lower disability identity. Disability identity scale was significantly correlated with higher social integration, higher social support and lower depression score. The newly developed disability identity scale will be a useful tool for the evaluation of the psychological status and planning the rehabilitation strategy for spinal cord injured persons.

Clinical significance of CA19-9 in mature cystic teratoma of the ovary / 대한산부인과학회지

OBJECTIVE: The aim of this investigation was to analyze the association between ovarian tumor markers and the clinicopathologic features of ovarian mature cystic teratoma. METHODS: The medical records of 195 patients whose pathologic diagnosis were made as mature cystic teratoma after surgery from June, 2000 to July, 2006 at Ewha Womans University Mok-dong Hospital were reviewed. The proportions of elevation of each tumor marker were evaluated in all patients and CA19-9 which showed the greatest elevation rate was selected as a promising relevant tumor marker. The patients were alloted to either Group I showing elevated CA19-9 or Group II showing normal level of CA19-9. The relationship between CA19-9 level and demographic data or clinicopathologic features were investigated by usual statistical method. RESULTS: The mean age of all patients was 35.4+/-12.8, and the average size of tumor was 7.1+/-3.5cm. Bilaterality of the mature cystic teratoma was 12.8%. The proportion of the patients showing elevated levels was greatest in CA19-9 as 33.3% (65/195), compared with 12.0% in CA-125, 5.8% in CEA, 1.1% in AFP. Significant difference between Group I and Group II were found in age, parity, tumor size, and bilaterality. Bilaterality and tumor size were greater in Group I, and age and proportion of parous women were lower in Group I. On the other hand, the rate of ovarian torsion or laparotomy conversion showed no difference. Likelihood ratio for bilaterality which may be clinically used during surgical procedure were 2.2 for CA19-9 suggesting its potential role in gynecologic practice. CONCLUSION: This study shows that CA19-9 may be a useful tumor marker associated with tumor size and bilaterality in ovarian mature cystic teratoma. Further confirmative study with larger sample size is in need in order to establish its definite clinical role in ovarian mature cystic teratoma.

Sudden rapid growth of an aggressive angiomyxoma after taking pomegranate seeds oil / 부인종양

Aggressive angiomyxoma (AA) is a rare soft tissue tumor of undetermined etiology that occurs mainly in the female vulva and perineum. It has been demonstrated to increase in size under the estrogenic stimulation and shown to respond to treatment with a GnRH agonist. A 47-year-old woman was presented with a large vulvar mass. The mass had grown slowly before she took pomegranate seeds oil on a regular basis for a year, which is known to contain natural estrogen for a year. The almond-sized mass enlarged into a fetal head-sized one in a year. Our case is implying that external administration of estrogenic substance may be a contributory factor to the sudden accelerated growth of AA. Although the past medical history in this case relies on an unverified observation by the patient alone, the unique clinical course and impressive gross appearance of AA may help clinicians with diagnosis in practice.

Serum Concentrations of Vascular Endothelial Growth Factor (VEGF) and placental VEGF expression in patients with preeclampsia / 대한산부인과학회지

OBJECTIVE: The goal of this study was to compare serum concentrations of VEGF, placental growth facto r(PlGF), soluble VEGF receptor-1 (sVEGFR-1) and the expression of VEGF-A in placental tissue from preeclamptic pregnancy with normal pregnancy. METHODS: From pregnant women with (n=46) and without (n=40) preeclampsia, maternal serum in third trimester and placental tissue at delivery were collected. The serum concentrations of VEGF, PlGF, and sVEGFR-1 were measured. The expression levels of VEGF-A protein in placenta were assessed using Western blot. RESULTS: The concentrations of total VEGF, PlGF were significantly decreased and that of sVEGFR-1 was significantly increased in patients with preeclampsia. The expression of VEGF-A protein was lower in preeclamptic placenta than in control placenta, but there was no significant difference. CONCLUSION: The abnormality of angiogenic factors (VEGF, PlGF, sVEGFR-1) may be important in the development of pathophysiology of preeclampsia. An elevation of sVEGFR-1 may lead to suppression of VEGF and PlGF effects, and also the down-regulation of VEGF-A protein in placenta may result in the decreased maternal vascular adaptation to pregnancy.

Lack of Association between L-myc Single Nucleotide Polymorphism and Cervical Cancer Susceptibility and Invasiveness in Korean Women / 대한산부인과학회지

OBJECTIVE: The aim of this investigation was to analyze the association between a single nucleotide polymorphism (SNP) in L-myc gene (T3109G) and the cervical cancer susceptibility or invasiveness in Korean women. METHODS: The blood samples of 231 cervical cancer patients and 332 non-cancer control subjects who managed at Seoul National University Hospital from 1999 to 2002 were collected. Polymorphism in L-myc (T3109G) was determined using TaqMan method. Allele frequency and genotype distribution in the cervical cancer group were compared with those of the control group to determine whether this polymorphism elevates the susceptibility of Korean women to the cervical cancer. The relationship between this SNP and cancer invasiveness was also evaluated by collating clinicopathologic data of those in the cancer group, such as age, FIGO stage, histologic type, lymph node metastasis and parametrial invasion. RESULTS: In the cervical cancer group, the allele frequency of G was 47.6%, in the control group 48.5%, showing no significant difference (p=0.808). Similarly the genotypes with TG or GG showed no increased risk for the cervical cancer compared with TT genotype. A subgroup analysis of the clinicopathologic parameters in cancer group also showed no significant difference suggesting the lack of an association between SNP of the L-myc and the cervical cancer invasiveness. CONCLUSION: This study shows that Korean women with specific polymorphism in L-myc are neither more susceptible to develop the cervical cancer nor more vulnerable for the cancer progression.

Clinical significance of atypical glandular cells on Pap smear / 부인종양

OBJECTIVE: We determine the rate of an atypical glandular cells (AGC) on cervical cytology and the incidence of clinical significant lesion on subsequent follow up biopsies. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells (AGC). METHODS: A total of 60,174 Pap smears were obtained between January 1st 2000 and December 31th 2005 at Ewha Womans University Mokdong Hospital. Among these smears, 26 patients had a diagnosis of AGC. Follow up was available for 23 patients (88.5%) and these patients had histologic follow up including cervical biopsy, endocervical curettage (ECC), and/or endometrial biopsy (EMB). RESULTS: Among 23 patients with AGC, eight (34.8%) were found to have a clinically significant malignant lesions on subsequent histologic follow up, including 2 endometrial adenocarcinoma cases, 1 cervical adenosquamous cell carcinoma case, 1 endocervical adenocarcinoma case, 2 vault adenocarcinoma cases, 1 MMMT case and 1 squamous cell carcinoma case. We found the differences in incidence of malignant lesions between premenopausal (23.5%) and postmenopausal (66.8%) patients with marginal significance (p=0.057). CONCLUSION: The incidence of AGC in Pap smear was 0.04%. The patients with AGC had a substantial risk of having a significant number of squamous or glandular, premalignant or malignant lesions. This study strongly suggests the need for the close follow up of patients with a diagnosis of AGC, especially in postmenopausal women.

Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy / 대한산부인과학회지

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.