Relationship between age at last delivery and age at menopause: The Korea National Health and Nutrition Examination Survey

OBJECTIVE: We used data from the 2010 to 2012 Korean National Health and Nutrition Examination Surveys to investigate whether the age at menopause is related to age at last delivery. METHODS: This was a cross-sectional study of the data for 714 women who became menopausal within the 3 years preceding the Korean National Health and Nutrition Examination Survey. RESULTS: Smoking, exercise, drink, educational level, and income were adjusted in model 1, and the mean ages at menopause were 50.5±0.3, 51.2±0.2, 51.2±0.3, and 50.2±0.4 years for women with <25, ≥25 and <30, ≥30 and <35, ≥35 years age at last delivery, respectively (P=0.049). Smoking, exercise, drink, educational level, income, age at first delivery, age at last delivery, and gravidity were adjusted in model 2, and the respective mean ages at menopause were 50.5±0.5, 50.7±0.4, 50.3±0.4, and 49.2±0.5 years (P=0.03). In both models, older age at last delivery showed higher age at menopause compared with women with younger age at last delivery. CONCLUSION: Korean women with older age at last delivery were associated with younger age at menopause. Increased number of pregnancies was related to older age at menopause.

Clinical Validation of AdvanSure GenoBlot Assay as Primary Screening and Test of Cure for Human Papillomavirus Infection

BACKGROUND: Clinical specificity and sensitivity are essential factors in the adoption of a human papillomavirus (HPV) test as a primary screening tool and test of cure after treatment of cervical cancer and precancerous lesions (High-Risk-Lesion). Using histologically-confirmed High-Risk-Lesion-patient specimens with postoperative follow-ups, we performed clinical validation of the AdvanSure GenoBlot Assay (GenoBlot; LG Life Sciences, Korea). METHODS: The study population included 100 cases with High-Risk-Lesion, 96 with high-risk genotype positive and cervical intraepithelial neoplasia (CIN) 1 or better, and 39 with HR-negative and better than CIN 1. Forty-eight High-Risk-Lesion cases received follow-up HPV exams after surgery. For validation as a test of cure, 48 preoperative specimens (PreOP) and 78 postoperative specimens (PostOP) from 48 subjects were separately analyzed. The results of HPV DNA chip tests (HPVDNAChip; BioMedLab Co., Korea) and sequencing were cross-compared. RESULTS: The concordance rates for each genotype between HPVDNAChip and GenoBlot were between 96.3-100%. The accuracy of HPVDNAChip and GenoBlot was 87.9% and 96.6%, respectively. Genotype-based specificity for High-Risk-Lesion detection was higher than 87% for both assays; genotype 16 showed the highest sensitivity. In the PostOP group, the positive rates for HPVDNAChip and GenoBlot were 30.8% and 47.4%, respectively. CONCLUSIONS: GenoBlot showed a higher positive rate than HPVDNAChip for each genotype, with concordance rate and accuracy being similar to previous reports. As a test of cure, GenoBlot performed better than the HPVDNAChip.

Small cell neuroendocrine carcinoma of the uterine cervix presenting with syndrome of inappropriate antidiuretic hormone secretion

Small cell carcinoma of the uterine cervix is rare. It is estimated that 10% of patients with small-cell lung cancer have syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and hyponatremia has been reported to be significantly associated with a poor prognosis. A proportion of small cell carcinoma of the uterine cervix exhibit neuroendocrine characteristics as revealed by immunohistochemistry, However, cases presenting typical symptoms due to SIADH are extremely rare. This report of the SIADH of the uterine cervix is a rare case in the small cell carcinoma of the cervix presenting with tumor-associated paraneoplastic syndrome.

Diagnostic Laparoscopy of Patient with Deep Vein Thrombosis before Diagnosis of Ovarian Cancer: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Epidemiological studies have demonstrated an increased risk of subsequent cancer in the patients who are diagnosed with idiopathic venous thrombosis. Cancers of the breast, lung and ovary in women and adenocarcinomas of an unknown primary cancer are most strongly associated with thrombosis. Mucin-producing cancers are most often associated with VTE and the highest rates of VTE were found for cases of ovarian cancer, but the absolute risk of cancer after thrombosis is relatively low (about 2% over the first year) and so the benefit of screening for cancer in thrombosis patients seems limited. But as this case, the association between thrombosis and occult cancer shows the importance of this association for patients who have thrombosis that is unresponsive to anticoagulant therapy. Especially, we should recognize that such patients can undergo investigation for an underlying malignancy. Diagnostic laparoscopy of an adnexal mass for confirming cancer in the acute setting of deep vein thrombosis (DVT) was performed for our patient. We report here on a case of a patient with DVT in the upper and lower extremities before the diagnosis of ovarian cancer, and we briefly review of the relevant literature.

A case of extraosseous ewing's sarcoma/primitive neuroectodermal tumor of the ovary / 대한산부인과학회지

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) family mainly occurs from skeletal system. ES/PNET from the female reproductive organs such as ovary and uterus has been reported very rarely. Recently, we experienced one case of malignant ovarian neoplasm, which was diagnosed as extraosseous ES/PNET of ovary and received operation and chemotherapy. So, we report this case and include a brief literature review.

Comparison of pregnancy prognosis by surgical management for Adnexal mass in pregnancy / 대한산부인과학회지

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.

Comparison of pregnancy prognosis by surgical management for Adnexal mass in pregnancy / 대한산부인과학회지

OBJECTIVE: To compare pregnancy prognosis by surgical management methods for adnexal mass in pregnancy, we evaluated laparoscopic surgery and laparotomy. METHODS: Between January 2000 and April 2008, 62 patients diagnosed with adnexal mass in pregnancy from St. Mary's hospital, Kangnam St. Mary's hospital, and Daejeon St. Mary's hospital were included. We performed a systemic retrospective chart review of patient who received by exploratory laparotomy or laparoscopy. The following factors were assessed: preoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complication and pregnancy outcome in both groups. Student's t-test and Fisher's exact test were used for statistical analysis. P-value below 0.05 was considered statistically significant. RESULTS: Laparoscopy 23 cases and exploratory laparotomy 39 cases underwent surgery during the study period. Lower abdominal pain due to cystic mass (50.0%) was the first operative indication and cystic torsion (30.6%) was followed. There was no difference in operative time, hospital stay, pregnancy outcome (spontaneous abortion, threatened abortion, preterm labor or birth) between two groups. But threatened abortion and preterm labor were increased in emergency operation than elective operation (P=0.028). Pregnancy outcomes were similar between laparoscopy and laparotomy. CONCLUSION: There was no difference in pregnancy complication and prognosis. Laparoscopic surgery can be managed safely as laparotomy in pregnancy women with adnexal mass.

Two cases of small bowel herniation through 5 mm trocar site following removal of drains after gynecologic laparoscopy / 대한산부인과학회지

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.

Two cases of small bowel herniation through 5 mm trocar site following removal of drains after gynecologic laparoscopy / 대한산부인과학회지

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.

Primary Carcinoma of the Fallopian Tube: Report of Two Cases with Literature Review / Journal of the Korean Cancer Association, 대한암학회지

Primary fallopian tube carcinoma (PFTC) is a rare tumor that histologically and clinically resembles epithelial ovarian cancer. PFTC has a worse prognosis than ovarian cancer as it is not routinely suspected and so treatment may be delayed. The early clinical manifestations and a prompt investigation can often lead to a correct diagnosis at an early stage. The preoperative diagnosis is usually difficult, and most patients with PFTC undergo laparotomy with the presumed diagnosis of ovarian carcinoma according to the presence of an adnexal mass. PFTC can present preoperatively as a tubo-ovarian abscess and it should be considered in the differential diagnosis of acute pelvic peritonitis. PFTC should be suspected by clinicians even if the presenting symptoms are atypical. We report here on two cases of PFTC along with a brief review of the literature.

Value of Human Papilloma Virus load in hybrid capture II assay to predict high grade cervical intraepithelial neoplasia in menopausal women with ASCUS or LSIL / 대한산부인과학회지

OBJECTIVE: To evaluate whether determination of the Human Papilloma Virus (HPV) viral load is helpful to predict the presence of high-grade cervical intraepithelial neoplasia (CIN) that requires aggressive treatment in menopausal women who have presented with an unsatisfactory colposcopic finding and ASCUS or LSIL. METHODS: In menopausal women with ASCUS or LSIL and with who were positive for HPV, 54 women had diagnostic conization were analyzed retrospectively. We used the Hybrid Capture II method. We classified women in a low-risk group (chronic cervicitis, CIN I) and a high-risk group (> or =CIN II) according to the pathological results of conization. We also classified patients into the HPV viral load or =100 RLU/PC group. We analyzed the relationship between the pathological results of conization and viral load. RESULTS: For the conization, 30 women had chronic cervicitis, nine women had CIN I, three women had CIN II and 12 women had CIN III. In the low Hybrid Capture titer-group ( or =CIN II pathology but in the high Hybrid Capture titer-group (> or =100 RLU/PC), 11 women had high risk pathology this finding was statistically significant (P=0.013). Compared to the low Hybrid Capture titer group, the relative risk of high grade CIN (> or =CIN II) in the high Hybrid Capture titer group was 2.043 (95% CI, 1.216~3.432). CONCLUSIONS: For menopausal women with an unsatisfactory colposcopic finding and also have ASCUS or LSIL women with high HPV viral load might have tendency of > or =CIN II pathology.

Placenta increta presenting as postabortal uterine mass and hemoperitoneum in the first trimester: A case report / 대한산부인과학회지

Placenta increta is one of lethal complications of pregnancy characterized by invasion of placenta villi into the underlying myometrium and usually presented in early postpartum period with difficult placental removal and massive bleeding. Placenta increta may complicate first and early second-trimester pregnancy loss causing profuse post-curettage hemorrhage but the lesion is rarely found and hard to diagnose. We experienced a case of hemoperitoneum caused by implanted chorionic villi on the uterine serosa regurged from uterine cavity, 6weeks after artificial abortion at gestational age of 5 weeks and 5 days.

Transcutaneous DNA immunization of HPV-16 E7 with hair-follicle specific promoter in mice / 대한산부인과학회지

OBJECTIVE: Previous reports have shown that transcutaneous immunization (TCI) with proteins or peptides in combination with adjuvants efficiently induces specific cellular and humoral immune responses. We compared the immune response after TCI with new construct which was derived from HPV-16 E7opt+K and pK6hf promoter instead of pCMV promoter and various adjuvant. METHODS: First, we made new construct ligated with HPV-16 E7 opt+K to Hair-follicle Specific pK6hf Promoter. Second, we applied pk6hf-E7 opt+K DNA with or without Lipofectamine 2000 and a combination of cholera toxin (CT) and CpG oligodeoxynucleotide (CpG) onto cold wax-depilated and hydrated bare skin of C57 BL/6 mice. To assess the ability of CTL(cytotoxic T-lymphocyte) activity, we performed intracellular cytokine staining with flow cytometric analysis to determine the number of E7-specific IFN-gamma- secreting CD8+ T cells generated in vaccinated mice with the DNA vaccine. RESULTS: Female C57BL/6 mice immunized by TCI methods with 30 microgram of pk6hf-E7 opt+K DNA with Lipofectamine2000 and CT efficiently generated E7-specific CD8(+) T cells compared with the group of pk6hf-E7 opt+K DNA only or DNA with Lipofectamine2000. CONCLUSION: Our results demonstrate that TCI of the linkaged-E7 DNA , E7 opt+K DNA to pk6hf, and Lipofectamine2000 and CT induced an antigen-specific CTL response. This result is of potential relevance for the development of therapeutic HPV-specific DNA vaccines with TCI and pK6hf promoter can be used safely.

Neurologic complications in operations performed in the lithotomy position / 대한산부인과학회지

OBJECTIVE: Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication. MATERIALS AND METHODS: We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period. RESULTS: Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (four patients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01) CONCLUSIONS: In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.

Application of experion(TM) assay system for discovery of ovarian cancer serum biomarkers / 대한산부인과학회지

OBJECTIVE: The discovery of new biomarkers for ovarian cancer is clearly necessary for the detection and monitoring of the disease. Experion(TM) automated electrophoresis system can be employed in the identification of differentially expressed proteins in cancer cells. The objective of this study was to discover potential diagnostic serological biomarkers for ovarian cancer. METHODS: We performed protein expression difference analyses for 14 healthy women and 28 ovarian cancer patients with stage I, III and IV using Experion(TM) system. And then we checked the protein expression as silver staining after loading at 8~16% gradient gel for comparison with Experion(TM) gel image. The candidate biomarkers were purified and determined using MALDI-TOF mass spectrometer. RESULTS: The distinctive polypeptide peaks were detected at 115.40, 15.96, 14.8, 11.66, and 10.69 kDa and these five peaks were identified as ceruloplasmin, hemoglobin beta chain, hemoglobin sigma chain, serum amyloid A4, and amyloid related serum protein SAA, respectively. These proteins were significantly different between the sera of normal healthy women and ovarian cancer patients. CONCLUSIONS: Five proteins were found to be significantly different between the sera of normal healthy women and ovarian cancer patients. In addition, Experion(TM) assay system can provide high performance for analysis of ovarian cancer-related proteins by increasing the throughput while maintaining a high level of accuracy.

Isolated torsion of fallopian tube during pregnancy treated with laparoscopic operation; A case report / 대한산부인과학회지

Isolated torsion of the fallopian tube is very uncommon during pregnancy. It usually confuses with acute appendicitis and torsion of the ovary. The diagnosis is usually established during operation, and a salpingectomy is almost always necessary. However, the early diagnosis and surgical treatment of the disease are mandatory to preserve oviduct. Because of safety and feasibility, laparoscopic surgery has recently become major treatment method.

A Case of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) Syndrome Supposedly Caused by the Paternity in Late Pregnancy / 대한주산의학회잡지

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) is a common dermatosis of pregnancy which usually occurs in the third trimester and generally in that of primigravida. Clinical feature is characterized by tiny erythematous papules which soon coalesce to form large, erythematous plaques. It generally occurs in abdomen, buttocks, thighs and upper inner arms. Since 1979 when Lawley et al. first described and reported PUPPP, there has been a lot of reports on PUPPP but the etiology is still not known. Many etiologic factors were reported but paternity as an etiologic factor was rarely reported. We had a very rare case which showed paternity could be one of the possible etiologic factors and we would like to share our case though this report.

Clinicopathologic characteristics and prognostic factors in adenocarcinoma of the uterine cervix / 대한산부인과학회지

OBJECTIVE: To evaluate clinicopathologic characteristics and prognostic factors in adenocarcinoma of the uterine cervix. METHODS: Medical records of patients with adenocarcinoma of the cervix who primarily underwent radical hysterectomy and pelvic lymphadenectomy (n=72) at A Hospital from August 1998 to July 2004 were retrospectively reviewed. Patients with stage IA1-IIB lesions were included in the study. Clinical and pathological data were reviewed and analyzed. RESULTS: Mean age at presentation was 46.5 years. The mean follow-up time for surviving patients was 35 months. The overall survival rate was 91.7% and disease free survival rate was 88.9%. Using univariate analysis, stage, lymph-vascular space invasion (LVSI), parametrial invasion, pelvic lymph node invasion and depth of stromal invasion were significant for survival, whereas grade, age, endometrial invasion were not significant. But using multivariate analysis, only stage and pelvic lymph node invasion remained significant independent predictors for survival. CONCLUSION: Our study demonstrates that survival rate is high for patients with early stage, after primary surgery. We found stage and pelvic lymph node invasion of significant prognostic value for survival in cervical adenocarcinoma.

The value of sentinel node HPV status for prediction of lymphnode metastasis and recurrence in cervical cancer patients / 부인종양

OBJECTIVE: The "sentinel node" is defined as the first lymph node encountered by lymphatic vessels draining a tumor. We tried to examine whether pathologic status of sentinel nodes of cervical cancer patients represent metastatic status of pelvic and paraaortic lymph nodes and to investigate the correlation between sentinel node HPV status and lymph node metastasis and recurrence of cervical cancer patients. METHODS: From August 2001 to December 2003, 57 patients affected by stage IB-IIA cervical cancer had sentinel node biopsies performed during radical hysterectomy and pelvic and paraaortic lymphadenectomy. We performed sentinel lymph node pathologic examination by frozen section and HPV typing by oligonucleotide microarray. After two years of follow up, we analyzed the prognosis of patients. RESULTS: Sentinel nodes were identified in all of our patients. A total of 79 nodes were detected as sentinel nodes. Metastasis in the sentinel nodes were found in 10 patients by frozen section and 11 patients by permanent pathologic examination. The results of sentinel lymph node frozen biopsy were statistically significant for predicting the metastatic status of the pelvic lymph nodes (p<0.05), but showed one false negative case. HPV DNA was detected in the cervices of 55 patients (96.5%), 44 (80.0%) of whom were found to have HPV DNA in the sentinel nodes. HPV DNA was detected in sentinel nodes of 10 patients among 11 patients with lymph node metastases. After mean follow up of 31.7 months (range; 1-48), disease recurred in five patients and all of these patients showed HPV in sentinel nodes. Combination of sentinel node frozen biopsy and HPV typing showed negative predictive value of 100% in predicting lymph node metastasis and recurrence. CONCLUSION: Our result suggests the possibility that sentinel node HPV typing would play a supportive role to reduce false negative rate of sentinel node biopsy. Additional study will be needed to confirm the clinical application of sentinel lymph procedure and to reveal correlation between HPV status of sentinel nodes and lymph node metastasis and recurrence of cervical cancer patients.

Proteomic analyses of cervical cancer tissues by two-dimensional gel electrophoresis and mass spectrometry / 대한산부인과학회지

OBJECTIVE: Comparison of protein expressions by two-dimensional gel electrophoresis (2-DE) in normal cervix and squamous cell carcinoma tissues in Korean women. METHODS: Normal cervix and squamous cell carcinoma tissues were solubilized with 2-DE buffer and the first dimension of PROTEAN IEF CELL, isoelectric focusing (IEF), was performed using pH3-10 linear IPG strips of 17 cm. And then running 12% sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and sliver stain. Scanned image was analyzed using PDQuest 2-D softwareTM. Protein spot spectrum was identified by assisted laser desorption/ionization-time of fighting (MALDI-TOF) and the protein mass spectrum identifications were performed by searching protein databases of Swiss-prot/TrEMBL, Mascot and MS-FIT. RESULTS: We found 9 up-regulation proteins (Alpha enolase, Keratin 19 type I, Keratin 20 type I, Keratin 13 type I, beta-actin, Aflatoxin B1 aldehyde reductase 1, Annexin A2, Squamous cell carcinoma antigen 2, unknown), 7 down-reguation proteins (Annexin 1, Myosin regulatory light chain 2, 14-3-3 protein epsilon, Heat shock 27 kDa protein, Hypothetical protein (DKFZP434C1715), Tumor necrosis factor receptor superfamily member 13B, Smoth muscle protein 22-alpha) and 6 up and down-regulation proteins (Tropomyosin 1, Tropomyosin 2, Tropomyosin 3, Serine (or cysteine) proteinase inhibitor, Phosphatidylinositol transfer protein alpha isoform, Src homology 3 domain-containing protein HIP-55) between normal cervix and squamous cell carcinoma cell tissues. CONCLUSION: 2-DE offers total protein expressions between normal cervix and squamous cell carcinoma cell tissues, and searching of differently expressed protein for the diagnostic markers of squamous cell carcinoma tissue.