Efficacy and safety of drospirenone 2 mg/17β-estradiol 1 mg hormone therapy in Korean postmenopausal women

This regulatory post-marketing surveillance study aimed to evaluate the therapeutic efficacy and safety of drospirenone (DRSP) 2 mg/estradiol (E₂) 1 mg tablet in Korean postmenopausal women. A total of 4,149 patients were enrolled and the study was conducted at 207 clinical research centers. The patients' source data was collected between November 2006 and November 2012. More than 85% of patients experienced improvement of menopausal symptoms. The most frequently reported adverse events were vaginal bleeding and breast pain; most of the women suffering from these symptoms fully recovered. The incidence of adverse event was higher in patients of younger age (20 to 39 years), in patients with concomitant diseases, previous hormone replacement therapy in medical history, those treated with DRSP 2 mg/E₂ 1 mg for shorter duration (3 years or less) and in patients using concomitant medication. In conclusion, the results from this large post-marketing surveillance study confirm the efficacy and safety of DRSP 2 mg/E₂ 1 mg tablet in Korean postmenopausal women.

A survey on the sexual behavior of adolescents in South Korea: The third survey in 2007 / 대한산부인과학회지

OBJECTIVE: The survey was conducted to improve the health of Korean adolescents and to prepare adequate teaching programs by investigating their sexual behavior. METHODS: The participants of the survey was 80,000 middle and high school students aged 13 to 18. The survey was conducted from September 1st, 2007 to September 22nd, 2007. RESULTS: 78,834 students were surveyed and 74,698 (94.8%) students responded the survey. 35,232 (47.2%) of respondents were male students and 39,466 (52.8%) of respondents were female students. 38,820 (52.0%) of respondents were middle school students, 25,051 (33.5%) of respondents were high school students and 10,827 (14.5%) of respondents were technical high school students. 5.2% of respondents experienced sexual intercourse. The average age of the first sexual intercourse was 14.2 years old. 1.0% of respondents had a sexual intercourse before they enter the middle school. The pregnancy rate was 0.3%. Among respondents who experienced sexual intercourse, the rate of the use of contraceptive methods was 38.2%. The rate of using inappropriate contraceptive methods was 21.6%. The average age of a first wet dream for boys was 13.2 years old. The average age of menarche for girls was 12.4 year old. The rate of respondents who had a sex education was 72.2%. CONCLUSION: The average age of the first wet dream and menarche had been decreased. The average age of the first sex experience among adolescents had been decreased. The rate of adolescents who experienced a sexual intercourse was increased. However, the rate of using reliable contraceptive methods was very low. Therefore, adequate sex educations including effective contraceptive methods needs to be conducted to prevent unwanted pregnancy of adolescents.

Sclerosing stromal tumors of the ovary occurred in various ages / 대한산부인과학회지

Sclerosing stromal tumor (SST) of the ovary is a rare, benign tumor. The most common clinical symptom is menstrual irregularity. Diagnosis of SST is often made by postoperative pathologic examination. The important differential diagnoses are other sex cord stromal tumors including fibroma, thecoma and etc. We present four cases of SST of the ovary during 10 years with a brief review of the literature.

A case of pelvic desmoplastic small round cell tumor in a old aged woman / 대한산부인과학회지

Peritoneal desmoplastic small round cell tumor is a very rare and highly aggressive neoplasm that predominantly strikes male children and young adults. It frequently presents as a large abdominal mass with widespread peritoneal involvement at diagnosis. We report one case of desmoplastic small round cell tumors in the pelvis in a old aged woman with a brief review of literature.

Torsion of the paratubal cyst in an adolescent female: A case report / 대한산부인과학회지

Torsion of the paratubal cyst is a rare but significant cause of acute or recurrent lower abdominal pain in adolescent females that is difficult to recognize preoperatively. Early diagnosis is very important in adolescent because of the risk of decreased fertility if it is not treated at an early stage. We report a case of torsion of the paratubal cyst that has resulted in hemorrhagic infarction of the paratubal cyst and fallopian tube in an adolescent female with brief review of literatures.

A survey of sexual behavior of teenagers in South Korea: 2006 / 대한산부인과학회지

OBJECTIVE: This research was performed to improve the health of Korean adolescents and to prepare adequate teaching programs by investigating their sexual cognition and behavior and preparing for adequate programs. METHODS: We conducted a survey of eighty thousand middle and high school students whose ages range from 13 to 18, during the period of September 1st, 2006 to October 30th, 2006. RESULTS: 78,593 people are polled and 71,404 people responded. Accordingly, the response rate was 90.0%: 52.1% (37,204) of the respondents were boys and 47.9% (34,200) were girls; 52.4% (37,420) of respondents were middle school students, 32.9% (23,500) of them were high school students, and 14.7% (10,479) of them were technical high school students. The rate of respondents who had experienced sexual relationship was 5.1%. The average age of starting sexual relationship was 14.2 year old. The rate of respondents who had experienced sexual relationship before they go to the middle school was 1.0%. The rate of pregnancy experience was 0.5%. The rate of respondents who were using a contraceptive method was 38.1%. The average boys age of having the first wet dream was 13.1 years old and girls of starting menstruation was 12.5 year old. The rate of using inappropriate contraception was 24.3%. The rate of having a sex education per a year was 62.0%. CONCLUSION: This research shows that the rate of adolescents who are experiencing sexual relationship is increasing. Besides, the age of adolescents starting sexual relationship is decreasing as their age of starting wet dream and menstruation decreases. As a result, it is strongly asserted that adequate sex education programs are indispensable to adolescents.

One case of adenomatoid tumor of uterus / 대한산부인과학회지

Adenomatoid tumor of uterus is described by Golden and Ash as a tumor that similar to adenoma but found obscured histogenesis. Adenomatoid tumor is a rare benign disease that originated from mesothelium and mostly occurred in male and rarely in female, and can be treated by simple excision of tumor because there is no recurrence or malignant change. We describe the clinical and histologic findings with references to other reported cases. We herein report a case of adenomatoid tumor of the uterus that gets an operation under clinical impression of myoma uteri.

A spontaneous pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages / 대한산부인과학회지

Ovarian failure and infertility are typical features in Turner syndrome. Conception without ovum donation is very rare. We experienced one case of pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages.

Two cases of cesarean section after laparoscopic radiofrequency myolysis / 대한산부인과학회지

Radiofrequency myolysis is a method for preserving uterus and fecundity, and due to its more non-invasive and simpler operation, it is now carried out to cure the uterine myomas. However, not long time has passed since this operation started, and little studies were conducted on this complications and side effects. Therefore, since the authors experienced the pregnancy after radiofrequency myolysis of uterine myoma, we hereby report the cases.

Clinical analysis of non-blood transfusion treatment in patients who refused a blood transfusion for obstetrical part / 대한산부인과학회지

OBJECTIVE: The goal of this study is to analyze the clinical manifestation of obstetrical patients who refused transfusion of any blood component. Through this analysis, we could define the guideline of non-blood transfusion treatment during the obstetrical procedure. METHODS: 127 patients who visited our non-blood transfusion treatment center and had obstetrical procedures from 1 Jan. 2000 to 31 March 2006 participated in this study. They were retrospectively analyzed according to the following indexes; the reason of refusing blood transfusion, age, ratio of vaginal delivery to Cesarean section, comparison of hemoglobin level, volume of blood loss, presence of bloodless treatment, days of hospitalization, presence of blood transfusion, consequence of patient (including complications and deaths). Bloodless treatment at the hospital are medical method (recombinant human erythropoietin, Aprotinin, Hemocoagulase, Tranexamine acid, Venoferrum), Autotransfusion and Electrocauterization. RESULTS: Among 126 patients (except for 1 patient who was delivered at the other hospital), the vaginal delivery group consisted of 57, and the Cesarean operation group was 69. The most common cause of primary caesarean section was arrest disorder of cephalo-pelvic disproportion. Among 26 patients qualified for indication of transfusion, uterine atony had the highest number of patients at 16. Among the indication of transfusion, low hemoglobin level (< or =8.0 g/dL) after operation had the highest number of patients at 20. Patients qualified indication of transfusion had twice more blood loss (464.6+/-34.2 ml vs 920.5+/-214.2 ml) and two more days of hospitalization (7.6+/-0.5 day vs 9.7+/-0.6 day) compared with those of non-qualified for indication of transfusion. Nobody received direct transfusion of blood component. There were no death but acute renal failure in one patient, and DIC (disseminated intravascular coagulation) in another patient as complications. CONCLUSIONS: This study analyzed the clinical manifestations of patients who refused a blood transfusion in obstetrics. Especially, when the non-blood transfusion treatment was performed, which had been an issue in recent times, more active treatment showed less reduction of hemoglobin level than no treatment. This study also confirmed that bleeding patients can be treated by selective non-blood transfusion treatment.

Acute Sheehan's syndrome with hyponatremia and hypoglycemia / 대한산부인과학회지

We report two cases of acute Sheehan's syndrome with a brief review of literature: A 28-year-old woman who had been performed cesarean section delivery complicated by hemorrhage due to uterine atony. And a 29-year-old woman who had vaginal birth after cesarean section (VBAC) complicated by hemorrhage due to birth canal laceration. On 8th day after delivery, both patient visited emergency room in critical condition with nausea, vomiting and general weakness. Although clinically significant Sheehan's syndrome is an uncommon consequence of obstetric hemorrhage, Sheehan's syndrome should be considered in the differential diagnosis of hyponatremia and suggestive hypoglycemia in early postpartum period women with history of massive obstetric hemorrhage.

Historical Changes and the Present Situation of Sexually Transmitted Diseases

STDs (sexually transmitted diseases) refer to a variety of bacterial, viral, and parasitic infections that are acquired through sexual activity including vaginal intercourse, oral sex, and anal sex. The term sexually transmitted infection (STI) is used increasingly because it has a broader range of meaning; a person may be infected and may potentially infect others without showing signs of diseases. Approximately 340 million new cases of STDs occur each year in the world. According to the Korea Centers for Disease Control and Prevention, notified cases of STDs in Korea decreased from 32,872 in 2002 to 12,486 in 2007. Bacterial STDs such as gonorrhea and chlamydial infection declined continuously but syphilis and chlamydial infection increased again. Viral STDs such as genital herpes and condyloma acuminatum increased continuously. Gonorrhea and chlamydial infection are still the two most commonly reported STDs in Korea. Bacterial STDs can be cured. However, the problem is that viral STDs cannot be cured completely at present. Safe sex with proper education and the correct use of condom are important to prevent STDs and unwanted pregnancy. Early diagnosis and screening, proper treatment, and appropriate counseling from qualified physicians are necessary to prevent the complications and spread of STDs. Also, continuous monitoring and strategies of prevention of STDs will be necessary for improvement of the public health.

CD99 activates T cells via a costimulatory function that promotes raft association of TCR complex and tyrosine phosphorylation of TCR zeta

We investigated the co-stimulatory role of a cell-surface protein, CD99. Co-ligation of CD99 and suboptimal CD3 induced T-cell activation to a level comparable to that obtained with optimal CD3 or CD3+CD28. We also noted concomitant enhancement of the earliest T-cell receptor (TCR) signaling events. In addition, co-ligation of CD99 and CD3 led to translocation of TCR complexes into the lipid raft, without concomitant migration of CD99 to the raft, and consequent enhancement of TCR zeta-mediated signal 1. These data demonstrate the unique properties of CD99 co-stimulation that distinguish this molecule from CD28 and other raft-resident co-stimulatory factors.

The effects of cervical conization on sexual function / 대한산부인과학회지

OBJECTIVE: This study is aimed to evaluate the effects of cervical conization on sexual function in patients with non-malignant conditions. METHODS: We choose thirthy-one patients who were operated by cervical conization. They were interviewed retrospectically that effects on sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. RESULTS: After cervical conization, there was no statistically significant change (p>.05) in sexual desire or interest, sexual activity or frequency, pleasure, communication and satisfaction with sexual relationship. CONCLUSION: Cervical conization was not found to have any adverse effects on sexual function in our study. In this respects, conization is a suitable conservative method when treating patients with non-malignant conditions.

Minimal invasive treatment of uterine myoma: Laparoscopic radiofrequency myolysis / 대한산부인과학회지

OBJECTIVE: To evaluate the feasibility, efficacy and safety of minimal invasive treatment of uterine myoma with laparoscopic radiofrequency (RF) myolysis. METHODS: 69 patients with symptomatic uterine myomas underwent laparoscopy assisted RF myolysis. The accurate targeting and thermal intensity during the procedure were guided by trans-vaginal ultrasound. The measurement of myoma volume and UFS-QOL (Uterine fibroid symptom-quality of life) were obtained once at preoperative period and four times at postoperative period of one week, 1, 3, 6 months. Wilcoxon signed rank test (SPSS 7.5) was used to compare the volume changes of myoma. A significant level of p<0.05 was considered. RESULTS: 107 fibroids were treated with RF myolysis. The mean duration of RF procedure was 15.2+/-18.5 minutes. Mean preoperative volume of treated fibroids was 75.7 cm3 (range: 8.2-367.7) and the mean volume decrease was 12.1+/-10.2%, 32.3+/-40.2%, 48.3+/-33.6%, 53.5+/-18.1% at one week, 1, 3, 6 months. Fifty eight patients had improved symptom severity with UFS-QOL score: symptom severity score 30.8+/-8.2 (mean+/-S.D.), quality of life score 20.3+/-9.2 after RF myolysis. There were 3 cases of RF heat related complication. CONCLUSION: Early experience of laparoscopy assisted RF myolysis in the treatment of uterine fibroids shows that the method is safe and effective under the guidance of trans-vaginal sonification.

Seroprevalence of parvovirus B19 in pregnant women in Korea: A study of sociodemographic and medical risk factors / 대한산부인과학회지

OBJECTIVE: The prevalence of Parvovirus B19 antibody in Korea has not been known. The aim of this study is to analyze variation of prevalence according to area, job and maternal age. METHODS: A prospective study of the pregnant women was performed at first & second trimester. This study was an analysis of 221 pregnant women who lived in Seoul, Bucheon, Cheonan, and Gumi in South Korea. All serum samples were drawn during first and second trimester. Presence of parvovirus B19 IgG antibodies and IgM antibodies was determined by ELISA using Parvovirus B19 IgM-3rd Generation EIA, Parvovirus B19 IgG-3rd Generation EIA, Parvovirus B19 Quantitative IgG Calibrators Kit (Biotrin International, Ireland). Data and level of significance were analysed by chi-square test using the SPSS program. RESULTS: In total, 118 (53.3%) of the 221 pregnant women were IgG antibody positive for parvovirus B19 during first and second trimester. Only 1 (0.5%) of 221 pregnant women was IgM antibody positive. There were no nonimmune fetal hydrops, spontaneous abortion and stillbirth in acutely infected woman. There were no statistically significant differences in Parvovirus IgG positive rate according to maternal age, area, parity and gestational age. CONCLUSION: This study has confirmed seroprevalence rate of human parvovirus B19 in South Korea comparable to the rate found in Asian countries. But positive rate of Parvovirus IgG was higher than other Asian countries. This study also showed that a proportion of adults of childbearing age was still susceptible to the virus and serological data also showed evidence of infection occurring in this age group. It will be of interest for the obstetricians in this country to note the role of Parvovirus B19 in relation to the extent of stillbirths and hydrops fetalis and to if there is any need for a vaccine to reduce fetal wastage.

A Case of Advanced Gastric Cancer in Third trimester / 대한산부인과학회지

Gastric cancer associated with pregnancy is extremely rare and the information on this particular subject is limited. Gastrointestinal symptoms such as abdominal pain, nausea, vomiting and loss of appetite are common during pregnancy but also can be the only symptoms in stomach cancer until the late stage. Clinicians' reluctance to pursue diagnostic studies appears to be a major contributing factor of delayed diagnosis and poor outcome. A 33-year-old-women at 30 weeks gestation with advanced gastric cancer died sixteen days after emergency cesarean delivery. We report this case to alert clinicians to this rare possibility.

Intravenous Iron in the Treatment of Postoperative Anemia Following Obstetric and Gynecologic Surgery / 대한산부인과학회지

OBJECTIVE: This study is aimed to evaluate the efficacy and safety of intravenous iron therapy (iron III hydroxide sucrose complex) in ptatients with postoperative anemia following obstetric and gynecologic operations. METHODS: We reviewed the data of 69 patients with postoperative anemia who had undergone obstetric and gynecologic surgery from September 2003 to September 2004, who refused transfusion for correction of post-operative anemia and agreed on treatment with intravenous iron therapy. Iron III hydroxide sucrose complex 200 mg diluted in 100 mL of 0.9% sodium chloride was administrated over 2 hours on postoperative day 1st, 3rd and 5th days. Hemoglobin levels checked and side effects were reviewed. RESULTS: After treatment of intravenous iron therapy, the hemoglobin levels increased rapidly. The lowest hemoglobin levels were observed on postoperative 3rd day but rapid increase of homoglobin levels were observed continously. After 2 weeks from operation, the hemoglobin levels have increased by 0.6+/-1.3 g/dL in the patients with cesarean section and 2.1+/-1.2 g/dL in the patients with gynecology operation. Major side effects such as anaphylaxis and allergic reaction were not observed, and minor side effects were observed in three patients (4%). Emesis, pain on the injection site and skin rash was observed in each patients. CONCLUSION: Intravenous iron sucrose therapy was safe and effective in anemia following obstetric and gynecologic surgery.

The guideline of management of sexual assault victim / 대한산부인과학회지

Because violent injury have increased in recent years, the sexual assault, or rape, is a significant and serious crime in our society. It is important that the physician be knowledgeable about the management of sexual assault victims. The role of physician evaluating the sexual assault victims has both medical and legal. The goals of intervention of sexual assault include identification and treatment of injury and infection, pregnancy prevention, evidence collection, and psychological assessment. Care violently injured victims that follows these guidelines is likely to ease assess and manage the patients and to promote patient's physical and psychological recovery.

The Clinical Significance of Uterine Artery Doppler Flow Velocity Waveforms as a Screening Test in the Second Trimester Pregnancies / 대한주산의학회잡지

OBJECTIVE: We performed uterine artery doppler flow velocity waveforms between 20~24 weeks of gestation to access the screening properties for predicting pregnancy-induced hypertension or intrauterine growth retardation in general population. METHODS: Total 458 normal pregnant women were enrolled in this study. The abnormal uterine artery doppler flow velocity waveforms was defined that systolic/diastolic ratio is greater than 2.6 or diastolic notch waveforms are seen. RESULTS: The incidence of PIH and IUGR among study population was 3.5% and 3.5%, respectively. The incidence of PIH in normal and abnormal uterine artery Doppler flow velocity waveforms group were 2.0% and 11.4%, and those of IUGR were 3.4% and 4.2%, respectively. The incidence PIH or IUGR among abnormal doppler group was 14.2%, which was higher than in normal group of 5.4%. This method had a sensitivity of 34.3%, a specificity of 86.1% and positive predictive value of 15.7% for the prediction of PIH and IUGR. CONCLUSION: Although abnormal uterine artery doppler flow velocity waveforms is associated with an increased risk of PIH or IUGR, the lowered positive predictability lead to apply the follow-up examination or standardization of doppler ultrasonography.