Primary nasal type NK/T cell lymphoma of the endometrium : A case report / 대한산부인과학회지

Non-Hodgkin lymphoma can involve the female genital tract usually as a manifestation of systemic disease, the vast majority of cases being B cell lineage. We report here one case of nasal type NK/T cell lymphoma arising in the uterus, of a 45-year-old Korean woman. The endometrium and myometrium showed diffuse infiltrative mass with hemorrhage and necrosis. Microscopic examination of the tumor revealed medium-sized atypical lymphoid cells. The tumor cells were positive for cytoplasmic CD3 and CD56, and were negative for vimentin, CD10, smooth muscle actin and desmin. Furthermore, In situ hybridization analysis for Epstein-Barr virus (EBV) RNA was positive. The histopathologic and immunohistochemical findings were consistent with extranodal nasal type NK/T cell lymphoma. We report this case to illustrate that NK/T cell lymphomas can involve, and rarely arise in, the gynecologic tract.

Surgical management of recurrent pneumothorax in the second trimester of pregnancy / 대한주산의학회잡지

Spontaneous pneumothorax in pregnancy is generally regarded as an unusual disorder, with only approximately 44 cases having been reported in the world literature. The most common cause is the rupture of a subpleural apical bulla or bleb, due to increased respiratory demand of the peripartum period. Pneumothorax should be considered in any pregnant woman with chest pain and/or dyspnea and must be confirmed radiographically. Treatment of simple pneumothorax during pregnancy is controversal. Admission and close observation of the patient is usually done with small pneumothorax. Other treatment options are needle aspiration, needle decompression (eg, intension pneumothorax), pleurodesis, tube thoracostomy, thoracotomy, and thoracoscopy. We report a recent experience of a 34 years-old pregnant woman with recurrent pneumothorax, who was treated with thoracotomy during the 28th weeks of pregnancy. She had previously been well during pregnancy and all antenatal investigations, including ultrasound scan, were normal. Cardiovascular examination did not reveal any abnormality. On chest auscultation, air entry was reduced on the left side of the chest. Chest X-ray revealed significantly expanded left lung with a large pneumothorax. After successfully treated with surgical approach, the patient had vaginal delivery of a healthy male infant, weighing 2.93 kg, safely during 39th weeks of pregnancy.

A case of bowel obstruction due to endometriosis / 대한산부인과학회지

We have experienced a case of intestinal obstruction due to endometriosis. It may involve intestinal wall and protrude into its lumen and patients with severe intestinal involvement usually require surgical resection. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. An emergency laparotomy was performed. The pathologic examination of the resected sample revealed endometriosis of sigmoid colon. Endometriosis can involve the intestinal tract extensively, causing a variety of clinical symptoms, and can result in a spectrum of mucosal alterations.

Clinical analysis of laparoscopic surgery of tuboovarian abscess in acute pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical characteristics between patients with tuboovarian abscess and those presenting with non-tuboovarian abscess in acute pelvic inflammatory disease according to the operation findings. METHODS: The patients were divided into 2 groups based on the operation findings at laparoscopic surgery; 56 patients diagnosed with evidence of tuboovarian abscess and 74 patients diagnosed with acute pelvic inflammatory disease without tuboovarian abscess. Those were compared with respect to patient characteristics, clinical and laboratory findings depending on the significant differences. RESULTS: There were no significant differences between the two groups considering the percentage of age, parity, mean abortion rate and rate of the history of previous pelvic inflammatory disease. But there were differences in mean white blood cell count, erythrocyte sedimentation rate and C-reactive protein level. A higher number of patients having intrauterine devices were observed in the tuboovarian abscess group than in the non-tuboovarian abscess group. Also, statistical significance was noted in hospital stay after operation but there was no difference in number of sick days prior to operation. CONCLUSION: Our results suggest that some variables noted between the tuboovarian abscess group and acute pelvic inflammatory disease group. These results make easier to calculate diagnostic accuracy of patients prone to developing tuboovarian abscess and prevent subsequent complications from the delay of treatment if sensitivity, specificity, negative and positive predictive values were assessed.

A case of ruptured tuboovarian abscess into the anterior abdominal wall / 대한산부인과학회지

Rupture of a tuboovarian abscess usually presents with sudden worsening of the patient's condition. Delays in surgical debridement and drainage increase the rate of associated mortality. A 39-year-old woman represents extraperitoneal spillage of abscess contents from rupture of a tuboovarian abscess into the anterior abdominal wall. She presented with gradually worsening abdominal pain over several months. She had fever, pelvic tenderness, an elevated white blood cell count and evidence of a tuboovarian abscess. Also she was found to have an abscess that had ruptured into the anterior left abdominal wall. After triple antibiotic therapy without a clinical improvement, she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and surgical debridement of the abdominal wall. Over the following several weeks, the patient required extensive wound care for wound drainage and skin flap.

A Case of Recurrent Aggressive Angiomyxoma of the Vulva / 대한산부인과학회지

Aggressive angiomyxoma (AAM) is an extremely uncommon neoplasm of the female genitalia. This tumor arises from soft tissue of the perineum, and affects predominantly young women. Although surgical excision with wide tumor-free margins may be necessary to obtain a complete cure, some of patients experience local recurrences because of the infiltrative nature of this tumor. We experienced a case of recurrent huge AAM on the right vulva in 29-year-old woman and reported it with a brief review of literature.

Comparison of diagnostic methods used for detection of preterm premature rupture of membrane / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to compare the detection rate among diagnostic methods used for preterm premature rupture of membrane (PPROM). METHODS: The study population was composed of pregnant women who visited delivery room at our hospital due to vaginal watery discharge from 1 March 2002 to 28 February 2003. The gestational age was between 15 and 36+6/7 weeks of gestation. The study group was composed of 74 pregnant women. The rupture of membrane was tested by nitrazine test, ROM-check test and actim PROM test. It was regarded true positive that normal spontaneous preterm delivery was occurred within 72 hrs. The detection rates of each test were analyzed. RESULTS: There were positive results in 65 cases of nitrazine test, 23 cases of ROM-check test and 53 cases of actim PROM test. Of these positive cases, cases that delivered within 72 hours were in 33 cases of nitrazine test, 13 cases of ROM-check test and 30 cases of actim PROM test. Among three diagnostic methods, the sensitivity is highest for nitrazine test (86.8%) and the specificity is highest for ROM- check test (72.2%). The positive predictive value shows no significant difference among three methods and the negative predictive value is highest for actim PROM test (61.9%). The combination of ROM-check test and actim PROM test shows most accurate detection rates for diagnosis of preterm premature rupture of the membranes (sensitivity 84.2%, specificity 42.3%, positive predictive value 56.1%, negative predictive value 64.7%). CONCLUSION: Our data shows that combination of diagnostic methods might improve detection rate for PPROM. Future studies remain to improve detection rate of PPROM.

Efficacy of Methotrexate in Management of Cervical Pregnancy / 대한주산의학회잡지

OBJECTIVES: This retrospective study was performed to evaluate the overall efficacy of methotrexate chemotherapy and to determine its proper management protocol in cervical pregnancy. METHOD: From January 1999 to May 2004, 44 patients of cervical pregnancy admitted in hospitals attached to Catholic University Medical Center. Among those, data of 35 cases received methotrexate therapy were analyzed. Clinical characteristics, route of methotrexate administration, concomitant invasive procedures, complications, and outcomes were analyzed. Analysis was performed by unpaired t-test, Fisher's exact test and Wilcoxon's rank sum test. RESULTS: The overall success rate of methotrexate was 82.9% and there was no significant difference according to viability, although initial beta hCG was significantly increased in viable pregnancy (p=0.0085). Major route of methotrexate was systemic in nonviable pregnancy and combined in viable pregnancy (p=0.035). In all patients who had a combination of systemic and local injection with methotrexate, treatment outcome was successful. Most common complication of methotrexate was liver toxicity, but not serious. CONCLUSION: Our results suggest that methotrexate treatment is effective as a therapeutic modality for early cervical pregnancy, but its administration route might be not related with efficacy. Furthermore, the combination of systemic and local intra-amniotic injection seems to be more effective.

Expression of E-cadherin and Catenin (alpha-, beta-catenin) in Endometrial Cancer and Atypical Complex Endometrial Hyperplasia / 대한산부인과학회지

OBJECTIVE: To evaluate the correlation of the expression of E-cadherin, alpha-catenin, beta-catenin and the clinicopathological features in endometrial cancer (EC) and atypical complex endometrial hyperplasia (ACEH). METHODS: Immunohistochemical (IHC) staining of E-cadherin, alpha-catenin, beta-catenin was performed in tissues of 6 ACEHs, 44 endometrioid ECs. We analyzed the correlation of the expression of IHC staining with the prognostic factors according to tumor stage of ACEH and EC, histopathologic grade, and myometrial invasion. RESULTS: According to tumor stage, reduced E-cadherin expression and abnormal alpha-catenin expression were observed more frequently in advanced stage (reduced E-cadherin: ACEH 0%, stage I-II 47.2%, stage III-IV 62.5%, p=0.050; abnormal alpha-catenin: ACEH 0%, stage I-II 27.8%, stage III-IV 62.5%, p=0.035). All of the IHC staining showed no correlation with the depth of myometrial invasion but showed correlation with presence of myometrial invasion (reduced E-cadherin: invasion(-) 14.3%, invasion(+) 66.7%, p =0.001; abnormal alpha-catenin: invasion(-) 7.1%, invasion (+) 46.0%, p=0.010; abnormal beta-catenin: invasion(-) 7.1%, invasion(+) 63.0%, p=0.000). According to histological differentiation only abnormal beta-catenin expression shows relationship with histopathologic grade (grade 1:23.1%, grade 2:60%, grade 3:62.5%, p=0.039). CONCLUSION: Expression of E-cadherin and alpha-catenin showed significantly more reduced expression in EC than in ACEH, and more reduced expression in advanced stage, myometrial invasion and high histopathologic grade. And alpha-catenin showed more frequent abnormal expression in advanced stage, myometrial invasion and beta-catenin showed more frequent in myometrial invasion, high histopathologic grade significantly. These results suggests that the expression of E-cadherin and alpha-catenin, beta-catenin in EC and ACEH could be related to prognosis of the tumor.

Conservative Medical Treatment of Intramural Pregnancies Diagnosed by MRI: Two Case Reports / 대한주산의학회잡지

Intramural pregnancy is one of the rare forms of ectopic pregnancy and the optimal treatment is unknown. We describe two cases of intramural pregnancy treated with systemic methotrexate, which were diagnosed by pelvic MRI. Medical treatment with methotrexate may be a conservative treatment alternative for intramural pregnancies.

A Case of Lymphocytic Hypophysitis Occurred in the Second-trimester of Pregnancy / 대한주산의학회잡지

Lymphocytic hypophysitis, a rare inflammatory disorder in the pituitary gland that is often associated with pregnancy, is caused by autoimmune destruction of the pituitary gland evidenced by diffuse lymphocytic infiltration in the pituitary gland. We report a case of lymphocytic hypophysitis in a 38-year-old woman presenting with aggravating headache and sudden visual loss during pregnancy, which was misdiagnosed as pituitary adenoma before neurosurgery. Magnetic resonance imaging, with enhancement, showed an expanding 2.5x2.0x1.7 cm sized sellar mass. The patient underwent transsphenoidal surgery with a preoperative diagnosis of pituitary macroadenoma. A histological examination revealed diffuse lymphocytes and fibrosis of adenohypophysis with atrophy, which are characteristic of lymphocytic hypophysitis. We report a case of lymphocytic hypophysitis occurred during pregnancy with a brief review of literatures.

A Case of Fetal Skin Bullae after Amnioinfusion / 대한산부인과학회잡지

Premature rupture of membrane generally leads to a poor perinatal outcome. For better perinatal survival, transabdominal prophylatic amnioinfusion and active expectant management was performed. We experienced a case of fetal right arm multiple skin bullae and stomach perforation after amnioinfusion. Underskin bullae was to disappear within a few days and stomach perforation site was treated by primary closure.

Cytogenetic Analysis in 3,503 Cases of Midtrimester Amniocentesis: CUMC Experience (II) / 대한산부인과학회잡지

OBJECTIVE: To analyze chromosomal abnormalities according to patient's age and indications of patients in midtrimester amniocentesis for prenatal genetic diagnosis. METHODS: We retrospectively analyzed 3,503 cases of midtrimester prenatal genetic amniocentesis cases which were done in the cytogenetic laboratory at Kangnam St. Mary's Hospital, Catholic University Medical College. RESULTS: In 3,503 cases, the most common maternal and gestational age distributions were 35 to 39 years old and 17 to 17 week 6 days (32.2% and 21.5%, respectively). Abnormal maternal serum markers was the most common indication for amniocentesis (46.4%), and followed by advanced maternal age (40.3%) and abnormal ultrasonographic findings (3.2%). The overall incidence of chromosomal abnormalities was 180 cases (5.1%), of which numerical abnormalities and structural abnormalities were 78 cases (2.2%) and 102 cases (2.9%), respectively. Among the autosomal abnormalities, Down syndrome was most common (33 cases, 0.9%), and followed by Edward syndrome (17 cases, 0.5%). Among the sex chromosomal abnormalities, 45,X was the most common (6 cases, 0.2%). Chromosomal abnormalities were most frequently noted in the maternal age 18-19 years old (14.3%), 40 to 44 years old (7.0%), 25 to 29 years old (6.1%), 30 to 34 years old (5.2%), and followed by 20 to 24 years old (4.1%). On the other hand, chromosomal abnormalities were most frequently noted in abnormal ultrasonographic findings (12.4%), previous history of aneuploidy (8.3%), and followed by family history of aneuploidy (7.0%). CONCLUSION: This study suggested that although advanced maternal age is still important indication in midtrimester amniocentesis for prenatal diagnosis, abnormal maternal serum markers and ultrasonographic findings might be also important as indications. Therefore, they should be considered in prenatal genetic counseling.

Umbilical Cord Arterial Blood pH Analysis at Term Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the gestational age adjusted values of umbilical cord arterial blood pH in term pregnancy with normal Apgar score. METHODS: We performed in attempt to compare umbilical arterial blood pH values for in term 757 singleton pregnancy, immediately after delivery of live-born infants delivery, with normal 1 and 5 minutes Apgar score. They were divided into 380 cases of normal full term vaginal delivery without any complication and 377 cases of elective cesarean section with normal fetal heart rate tracing. We determined gestational age, parity, Apgar score. RESULTS: There was a significant decline correlation between gestational age and umbilical artery pH (P=0.018). In acidemia, the odds ratio was increasing from 37 weeks to 41 weeks but there was no association between normal Apgar score and pH less than 7.10 with increasing gestational age. We evaluated the umbilical artery pH level in different delivery mode. In uncomplicated normal vaginal delivery, negative significant correlation was found (P=0.022), and elective cesarean section case did not show a statistically significant level. CONCLUSION: Our data suggested that umbilical artery pH has a negative relation with gestational age during term period.

Development of Trans Attack Anticancer Gene Vaccine Interact in HPV Oncoprotein Expression Inhibition / 대한산부인과학회잡지

OBJECTIVE: Adeno-associated virus Rep 78 protein is known to inhibit the promoter site of several onco-genes and viral gene, including the human papillomavirus type 16 E6 transforming genes. In this study, we investigated AAV Rep 78 mediated inhibition of HPV 16 E6 promotor activity. METHODS: pcDNA3.1/V5/His-Topo vector, cloned by AAV mediated Rep 78, is transfected into cervical cancer cell line (Caski). After that, we confirmed HPV16 derived E6 expression and cell growth inhibition. RESULTS: Transfection rate of Rep78 GFP-vector, approximately from 30 to 60 per-cent, is highly expressed at first day. But E6 expression is lower at this day. The growth of CaSki and HeLa cervical cancer cell lines was inhibited by Rep78 (p<0.05). But, the other cervical cancer cells were unaffected by Rep78 transfection. CONCLUSION: In spite of the high Rep78 transfection efficiency and expression rate, we could not show the cervical cancer cell growth inhibition. In our data, long term expression of Rep78 strategy is needed for cervical carcinoma gene therapy using adeno-associated virus vector.

Association of Osteoprotegerin Gene Polymorphisms with bone Mass in Postmenopausal Korean Women / 대한산부인과학회잡지

OBJECTIVE: To examine the relationship between Osteoprotegerin gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Osteoprotegerin A163G, T950C, G1181C gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. The subjects were divided in normal, osteopenic and osteoporotic on the basis of the T-score values according to the classification of the World Health Organization (WHO). RESULTS: The genotype distribution of A163G, T950C and G1181C polymorphisms in all postmenopausal women was as follows: AA 54.6%, AG 37.1%, GG 8.3%, T/T 17.5%, T/C 44.1%, C/C 38.4%; GG 52.4%, GC 38.0%, CC 9.6%, respectively. Significant differences in the distribution of A/A and A/G genotype among osteoporotic group were observed. No significant differences in the distribution of T950C and G1181C genotypes among three groups were observed. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A163G polymorphism was significantly associated with BMD at the lumbar spine in normal and osteoporotic patients and BMD at the femur neck and wards triangle in normal patients, and G1181C polymorphism BMD at the trochanter in all groups and BMD at the femur neck in osteopenic and osteoporotic patients, and BMD at the wards triangle and trochanter in osteoporotic patients. But There was no relationship between T950C gene polymorphism, and BMD. CONCLUSION: These findings suggest that osteoprotegerin gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.

Prevalence of Chlamydia Trachomatis and Relation with Human Papilloma Virus / 대한산부인과학회잡지

OBJECTIVE: One of the most common causative microorganisms in pelvic inflammatory disease (PID) is the chlamydia trachomatis. In many cases chlamydia trachomatis infection has weak and nearly absent symptom, but it's endocervical infection usually disseminates into upper genital tract. In this infection tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic infection has involved. In this study, we investigated the prevalance of chlamydia trochoma infections in symptomatic and asymptomatic women and its relation with Human Papilloma infection. METHODS: From Jan, 1999 to July, 2003, in St. Vincet's Hospital, The Catholic University of Korea, endocervial swabs were obtained in 3416 patients (1137 in Heath Promotion Center, 2226 in OPD) by Amplicor Chlamydia Trahomatis Kits (STD swab specimen collection transprt kits). Chlamydia trachomatis DNA was extracted and amplified by PCR assays to investigate the prevalence. Also in this study we investigated the prevalence of human papilloma virus by hybrid capture method. Women who visted Hospital were received routine gynecologic examination, history taking, and physical examination and information on potential risk factors was obtained by questionnaire. RESULTS: The prevalence rate of Chlamydia trachomatis in symptomatic women was 12.6% and there was a high peak prevalence among the early twenties (66%). The prevalence rate of Chlamydia in asymtomatic women was 8.2% but there was no peak in early twenties. In asymptomatic woman, asymptomatic chlamydia infection can be statistically anticipated by 1) Economic status, 2) Occupation status, 3) Alcohol intake, 4) History of Gynecologic disease, 5) History of STD. Women with chlamydia infection was 1.5 times greater risk of coincidal HPV infection and was statistically significant. CONCLUSION: The prevalence rate of chlamydia infection is higher than any other developed country, especially in asymptomatic women. Although symptoms are weak, the rate of prevalence and complications can be reduced by the screening of chlamydial infection.

A Study on the Leptin Concentrations in Maternal and Cord Blood / 대한산부인과학회잡지

OBJECTIVE: In this study, We investigated the circulating level of leptin in the maternal and cord serum to estimate the effect of leptin on the fetal growth. METHODS: In full-term pregnancy, right after delivery, we calculated the concentration of leptin in the maternal and cord serum by using an immunoassay. we studied the relation between these value, the maternal BMI at the time of delivery, the neonatal body weight. RESULTS: At the time of delivery, mean concentration of maternal leptin and cord leptin showed 335.7 pg/ml and 118.3 pg/ml and there was no statistical significance between them. Mean concentration of matenal leptin has positive relation with maternal body weight. but not to neonatal weight. Mean concentration of cord serum leptin has a positive relation with neonatal weight. There was a correlation between the maternal BMI and the neonatal weight at the time of delivery. We evaluated the mean leptin level of neonates of two different sexes, that difference did not show a statistically significant level. CONCLUSION: In this study, no correlation was found between concentration of maternal leptin and cord leptin. These data suggested that the cord serum leptin has a positive relation with fetal growth independantly, regardless of maternal leptin and maternal BMI.

A Case of Ruptured Cornual Pregnancy in Adenomyosis Uterus at 29 Weeks' Gestation / 대한산부인과학회잡지

A case of ruptured cornual pregnancy in adenomyosis uterus at 29 weeks' gestation is presented here. A cornual pregnancy occurs when the conceptus implants at the junction between the tube and the uterus rather than in main part of uterine cavity. It is relatively rare entity, but the rich vascularity of the uterus in this location makes rupture particularly dangerous. resulting in higher maternal mortality. The presented case was unique in continuing till the third trimester of pregnancy. We present a case of a ruptured cornual pregnancy in adenomyosis uterus at the third trimester of pregnancy with a brief review of literatures.

Misplaced IUD / 대한산부인과학회잡지

OBJECTIVE: To study intrauterine or extrauterine misplacement of intrauterine devices in respect to their usage in diagnosis and therapy via retrospective analysis. METHODS: Data from 1993 to 2000 on a total of 32 patients from seven Catholic University branch hospitals who had been admitted to treat IUDs which had misplaced to intrauterine or extrauterine locations were analyzed for usage in a retrospective study. RESULTS: The data for intrauterine and extrauterine misplacement revealed no significant difference between from the statistical average in relation to age, parity and duration of insertion. In terms of removal method, all 15 patients with extrauterine misplacement underwent surgical extraction by open or laparascopic method under general anesthesia, but those patients with intrauterine misplacement had their device removed after cervical dilatation with a laminaria using local anesthesia. Concerning diagnosis, 81.2% of extrauterine misplacement were diagnosed using x-ray while 58% of intrauterine misplacement were diagnosed using vaginal US. The result of the Fisher's exact test showed a significant difference (p=0.043) in the rate of diagnosis for intrauterine and extrauterine misplacement of IUDs. Also, the results of multi-variable analysis performed for logistical regression analysis showed that intrauterine misplacement occurred 1.23 times more frequently than extrauterine misplacement. CONCLUSION: Further studies are required on a broader patient population, on more types of IUDs and with time variables taken into account. Despite more research, prevention of complications such as misplacement remains the most appealing situation, being influenced by such factors as technical skill of the physician inserting the IUD, appropriate duration of insertion and proper patient education.