Expression of aromatase in endometiosis and its relation to clinical laboratory and surgical parameters / 대한산부인과학회지

OBJECTIVE: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. METHODS: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. RESULTS: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. CONCLUSION: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.

Update in Laparoscopic Hysterectomy and Laparoscopic Myomectomy / 한양의대학술지

The role of laparoscopic hysterectomy (LH) in current gynecological practice has yet to be defined. Randomized trials have demonstrated that, compared to abdominal hysterectomy, LH shortens hospital stay and induces less postoperative pain and quicker recovery. Some retrospective publications it seems that complication rates have increased in LH, especially those involving the urinary system. However, a recent analysis revealed a reasonable complication rate for the procedure, compared with abdominal hysterectomy, Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive procedure that was developed during the 1990s as a treatment for abnormal uterine bleeding. The literature regarding this procedure, mainly case series and retrospective comparisons, suggests that LSH results in reduced operating time and blood loss and a quicker return to normal activity, compared with laparoscopic-assisted vaginal hysterectomy (LAVH). Given the lack of appropriate randomized, controlled trials and the limitations of the existing research, the LSH's true value and appropriate clinical indications remain unknown Uterine fibroids are the most common benign tumors of the uterus. Management depends on the symptoms, location and size of the fibroids, and the patient's desire to conceive. Surgical management of uterine fibroids has changed from laparotomy to minimally invasive surgery. Advances in surgical instruments and techniques are expanding the role of laparoscopic myomectomy in well-selected ndividuals. Meticulous repair of the myometrium is essential for women considering pregnancy after laparoscopic myomectomy to minimize the risk of uterine rupture. Laparoscopic myomectomy is an appropriate alternative to abdominal myomectomy or hysterectomy.

Fetal Choledochal Cyst Diagnosed at 22 Weeks of Gestation by Three-Dimensional Ultrasonography: A Case Report

Choledochal cyst is a cystic or fusiform dilatation of the extra- or intrahepatic bile duct that has rarely been reported in prenatal cases. Here we report a fetus with choledochal cyst diagnosed prenatally by three-dimensional (3-D) ultrasonography at 22 weeks of gestation. We demonstrated an image of choledochal cyst by using a new ultrasound technique, a 3-D multislice view. After close intrauterine followup, surgery was successfully performed and postoperative course was uneventful.

Comparison of single-dose and multiple-dose systemic methotrexate treatment followed by aspiration curettage and local methotrexate injection in treatment of cervical pregnancy / 대한산부인과학회지

OBJECTIVE: To compare the clinical efficacy of systemic single-dose and multiple-dose methotrexate (MTX) regimens combined with aspiration curettage and local MTX in treatment of cervical pregnancy. METHODS: Between January 2000 and December 2006, 40 cases of cervical pregnancies were treated with combined systemic and local methotrexate therapy at the Department of Obstetrics and Gynecology, Chung-Ang University Hospital. The patients were treated with either of the two regimens:a) Single dose regimen (Group 1): 1 mg/kg of intramuscular MTX with leucovorin treatment (18 cases).b) Multiple dose regimen (Group 2): four doses of 1 mg/kg of intramuscular MTX with leucovorin treatment (22 cases). Combination treatment with aspiration curettage and local MTX injection were done in all patients after clinically indicated.Baseline characteristics, regimens used and number of doses administered, treatment outcome, presence and severity of side effects were analyzed. RESULTS: The mean age of the patients was 28+/-2.8 vs 28.4+/-2.4 years and gestational age at diagnosis was 49.4+/-8.3 vs 56.4+/-7.4 days. Initial level of serum beta-hCG ranges was 3,242.2+/-189.2 vs 2,864.3+/-172.4 IU/mL. There were no significant differences in initial beta-hCG values, gestational age between single-dose group and multiple-dose groups, The overall success rate of MTX management for an ectopic pregnancy was 82.5% (33/40) with 66.7% (12/18) and 95.5% (21/22) for single and multiple dose groups respectively. Multiple dose group had more rapid downward trend of hCG and more rapid stabilization. Side effects occurred in 20% (8/40) of the study group with 16.7% (3/18) and 22.7% (5/22) for single and multiple dose groups respectively but not significant. CONCLUSION: Systemic single-dose and multiple-dose MTX regimen combined with local MTX injection with aspiration curettage and local MTX injection is an effective and safe treatment modality for cervical pregnancies. In our study, multiple-dose regimen treatment is more effective, mild side effects comparable with single dose regimen. Further comparative studies with long-term follow-up are needed to evaluate reproductive outcome and to reduce side effects.

Studies on the Effects of Monoclonal Antibodies to Mammalian Heat Shock Protein 60 (HSP 60) on Mouse Embryo Development In Vitro / 대한산부인과학회잡지

OBJECTIVE: To investigate the effects of antibodies to HSP 60 on the early mouse embryo development in vitro. METHODS: The 175 late 2-cell mouse embryos were obtained from 6-7 week old female ICR mice. 5-10 embryos were placed in each well. The embryos were incubated in the Ham's F-10 medium supplemented with 100 microgram/mL of monoclonal antibody to HSP 60 (66), monoclonal mouse IgG1 (55), and medium alone (54), respectively, at 37degrees C in a 5% CO2 humidified air chamber, and mouse embryo developments were observed daily. RESULTS: On day4, growth arrests were more prominent in anti-HSP 60 containing group compared to IgG1 containing group, medium only group (0% vs 16%, 14%), and these results were statistically significant (p=0.0032). Especially those inhibitory effects were observed in early stage of embryo development (day1) and these results were also statistically significant (31% vs 83%, 77%, p<0.0001). Moreover, we found out that cellular degenerations were more common in anti-HSP 60 containing group and this features were prominent on day2. CONCLUSION: Anti-HSP 60 elicited a strong growth inhibitory and degenerative effect on early mouse embryo development. These findings suggest that HSP 60 may exert a protective effect against mouse embryo degeneration or apoptosis.

Studies on Pregnanacy Rate of Controlled Ovarian Hyperstimulation before Intrauterine Insemination in the Treatment of Unexplained Infertility / 대한산부인과학회잡지

OBJECTIVE: To determine which regimen for controlled ovarian hyperstimulation is the most effective in achieving pregnancy after intrauterine insemination in the treatment of unexplained infertility. MATERIALS AND METHODS: From March 1996 to February 2000, a total of 67 cycles of intrauterine insemination after controlled ovarian hyperstimulation were treated in 39 patients under 40 years old who diagnosed as unexplained infertility. Two methods of controlled ovarian hyperstimulation were used. The one is clomiphene citrate/hMG and the other is hMG only. These were compared the pregnancy rate respectively. RESULTS: Mean age of study group was 32+/-2.7 years old (28-38 years old) and mean duration of infertility was 46+/-17.8 months (15-96 months). The overall clinical pregnancy rate was 17.9% (12/67 cycle) per cycle and 30.7% (12/39 patient) per patient. According to the methods of controlled ovarian hyperstimulation, pregnancy rate was 16.7% (8/48 cycle) after clomiphene citrate/hMG used, 21.1% (4/19 cycle) after hMG only used. 4 cases of ovarian hyperstimulation syndrome developed (clomiphene citrate/hMG 1 case, hMG only 3 cases) and all of them were self-regressed. CONCLUSION: Compared with using hMG only as controlled ovarian hyperstimulation before intrauterine insemination, using clomiphene citrate/hMG was more effective regimen and considered as the first choice in the treatment of unexplained infertility.

Effects of Coculture of Vero Cells on the Development of Frozen-thawed Two-cell Stage ICR Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: The rate of developmental progression of frozen-thawed embryos is lower than that of nonfrozen embryos in mice, cows, humans and other mammalians. This study was designed and performed to evaluate the beneficial effects of coculture of Vero cells on the development of frozen-thawed two-cell stage embryos of ICR strain mice. MATERIASL AND METHODS: The late two-cell stage mouse embryos were obtained from oviducts of 5~6 week old mated ICR mice superovulated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Two-cell stage mouse embryos were frozen slowly with 1,2-propanediol and sucrose as cryoprotectants and thawed rapidly, followed by stepwise dilution. The frozen-thawed embryos were cultured in Ham's F-10+10% Fetal Bovine Serum (FBS) basal culture medium with and without Vero cells. The rates of development in both groups were compared every 24 hours for 5 days. RESULTS: Vero cells did not significantly stimulate the rate of embryonal development compared to controls at 24 hours after culture, 124 (69.3%) and 68 (61.3%), respectively (p=0.161). On day 4, however, 55 (30.7%) cocultured embryos had developed to expanded-hatching blastocysts, which was the significantly higher number than that of the embryos in controls: 16 (14.4%) (p=0.002). In addition, more embryos in coculture developed to hatching-hatched blastocysts (43[24.0%]) compared to the controls (10[9.0%]) (p=0.001). CONCLUSION: Coculture of cryopreserved embryos after thawing with Vero cells seems to be an useful tool to remove the postthaw deleterious effects of freezing and to obtain better quality embryos appropriate for transfer. These beneficial effects of Vero cell coculture appear to become more prominent as the embryonic development progresses over time.

A Case of Holoprosencephaly / 대한산부인과학회잡지

Holoprosencephaly is a rare developmental defect due to incomplete cleavages of the prosencephalon during the third week of fetal development. It was associated with chromosomal anomalies, genetic syndrome, teratogen, or genetic disorder of non-syndromic HPE. Early antenatal detection of holoprosencephaly was done by high resolution ultrasonography. According to its severity and prognosis, it was capable of proper treatment of holoprosencephaly. We report one case of holoprosencephaly with a brief review of the literature

Two Cases of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회잡지

Primary peritoneal serous papillary carcinoma (PPSPC) is very rare and not well identified. Because of developmental, biological and histologic similarity to papillary serous carcinoma of ovary its diagnosis and treatment, prognosis and post treatment follow up schedule is similar that of epithelial ovarian cancer. We have experienced two cases of primary peritoneal serous papillary carcinoma and report this with brief review of the concerned literatures.

Two Cases of Primary Peritoneal Serous Papillary Carcinoma / 대한산부인과학회잡지

Primary peritoneal serous papillary carcinoma (PPSPC) is very rare and not well identified. Because of developmental, biological and histologic similarity to papillary serous carcinoma of ovary its diagnosis and treatment, prognosis and post treatment follow up schedule is similar that of epithelial ovarian cancer. We have experienced two cases of primary peritoneal serous papillary carcinoma and report this with brief review of the concerned literatures.