IL-18Ralpha Mediated GATA-3 Induction by Th2 Cells: IL-12 Supports IL-18Ralpha Expression in Th2 Cells

BACKGROUND: IL-18 was originally cloned as a IFN-gamma inducing factor in primed T cells. In synergy with IL-12, IL-18 has been shown to induce strikingly high levels of IFN-gamma production by T cells and to enhance Th1 development. Also this cytokine exerts induction of Th2 development through IL-4 induction. METHODS: Resting CD4+ T cells were sorted by negative selection and activated by anti-CD3 plus anti-CD28 Ab. Expression of IL-12 binding sites, IL-18 binding sites, IL-18Ralpha, and GATA-3 mRNA were analysed by FACS and RT-PCR, respectively. RESULTS: Resting CD4+ T cells expressed IL-18Ralpha chain but not IL-18 binding sites, suggesting a lack of IL-18Rbeta expression. IL-18Ralpha was maintained on the Th1 and Th2 committed cells. IL-18 binding sites were induced on the Th1 but not Th2 cells. Exposure of these cells to IL-18 led to up-regulation of GATA-3 mRNA expression only in Th2 committed cells. To elucidate the relationship between IL-18Ralpha expression and GATA-3 induction by IL-18, Th1 and Th2 committed cells were further cultured in medium with or without IL-12 for 2 days. IL-12 binding sites were maintained on the Th1 and Th2 cells regardless of IL-12 treatment, but IL-18Ralpha expression was rapidly down-regulated on the IL- 12-untreated Th2 cells which did not induce GATA-3 mRNA expression followed by IL-18 stimulation. CONCLUSION: IL-12 supports expression of IL-18Ralpha and GATA-3 mRNA expression was induced by IL-18 through IL-18Ralpha without expression of IL-18 binding site in Th2 cells.

A Case of Cystic Lymphangioma of the Scrotum and Retroperitoneum was Detected in Fetus / 대한산부인과학회잡지

Cystic lymphangioma is a relatively rare congenital malformation of the lymphatic system. It is very rare that retroperitoneal cystic lymphangioma was detected by prenatal ultrasonography. There has been no case reported that scrotal cystic lymphangioma was detected by prenatal ultrasonography. We detected a cystic structure with multiseptation in the scrotum at 30 weeks gestation. In addition, we detected the same structure in the retroperitoneum at 35 weeks gestation by routine ultrasonography. Because of increasing size of the cyst, we performed induction delivery at 38 weeks gestation. Operation of the neonate was performed on the 13th day after birth by a pediatric surgeon and the mass was excised and confirmed as cystic lymphangioma. We experienced a case of huge cystic lymphangioma of the retroperitoneum and scrotum by prenatal sonography and report our case with a brief review of literature.

A Case of Krukenberg Tumor arising from Appendix / 대한산부인과학회잡지

Krukenberg tumor arising from an appendiceal neoplasm is rare. The 30 cases of appendiceal Krukenberg tumor have been reported since 1970 currently. The tumors can be easily overlooked because appendiceal tumors are rare and its size is very small so that they can be seen normally to the naked eye. The proper treatment of tumors which spreads from the appendix to the ovary does not exist as of yet, so the mean survival time is only 7-9 months and the prognosis is not good. Therefore, when the ovarian tumor that secrete the mucus substance is found and primary origin cannot be found, diagnostic appendectomy is recommended. Authors report a case of the 46-year-old woman who admitted with chief complaints of palpable abdominal mass which reveals Krukenberg tumor from appendix.

A Case of Spontaneous Rupture of a Splenic Artery Aneurysm in the Third Trimester / 대한산부인과학회잡지

The spontaneous rupture of splenic artery aneurysm during pregnancy is a rare but catastrophic event. Two thirds of all ruptures happen during the third trimester. Clinical presentation is often non-specific, with good hemodynamic compensation, followed by a rapid deterioration. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately. We report a case of a patient at 38 weeks of gestation suffering epigastric pain and fetal distress. At emergency cesarean delivery, an aneurysmal rupture of the splenic artery was found to be the reason for the hemoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. In spite of fatal hemorrhage, the patient survived but her fetus was dead. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.

A Case of Heterotopic Pregnancy / 대한주산의학회잡지

No abstract available.

Two Cases of Endometriosis in the Extraperitoneal Portion of the Uterine Round Ligament / 대한산부인과학회잡지

Extraperitoneal inguinal endometriosis often presents as an inguinal mass in women of reproductive age, Approximately 40 cases of inguinal endometriosis have been documented in the sutgical and gynecological literature. The overall incidence is in the range of 0.4% of patients with endometriosis. The right side is much more commonly involved than the left (almost 90% of the time in one series of 23 patients), and rarely is the condition bilateral. The most frequent complaint of patients with inguinal endometriosis is an inguinal mass, followed by pain and enlargement of the mass near menstruation. Authors have experienced two cases of endometriosis of the extraperitoneal portion of the round ligament of uterus and report with a brief literature review.

The Clinical Significance of Increased Serum CA 125 in Asymptomatic Women / 대한부인종양콜포스코피학회잡지

OBJECTIVES: Our study was to determine the usefulness of CA 125 screening for asymptomatic female subjects. Though CA 125 has been used as a useful marker for the detection of ovarian cancer, its efficacy to detect early ovarian cancer in asymptomatic women has not been established. STUDY DESIGN: From April 1995 to December 1997, a total of 13,038 subjects who visited our Center for Health Promotion were screened. Serum CA 125 level was measured by a radioimmunoassay kit (Centocor, USA). In most cases transvaginal ultrasound was done at the same time. The specificity, sensitivity and positive predictive value were obtained on the basis of normal CA 125 range between 2.4~36.3 U/ml. RESULT: 1) Two cases of ovarian cancer were detected out of 13,038 subjects screened. One ovarian cancer patient showed 1,625 U/ml of CA 125 level, on the other hand, the other level patient showed 27 U/ml. 2) Therefore, the sensitivity, specificity, and positive predictive value were 50%, 97.3%, and 0.3%, respectively. Since 346 cases out of 13,038 screened subjects showed false positive results on the basis of the upper limit of normal CA 125 level set at 36.3 U/ml,the false positivity was 2.6%. 3) The CA 125 levels in false positive cases ranged from 36.3 U/ml to 352.8 U/ml with the mean value of 66.19+/-51.47 (S.D.). 4) The clinical features of the false positive cases included uterine myoma including adenomoysis (150), benign ovarian cyst (19), cervicitis (6), tuberculosis (3), pregnancy (2), and each one case of breast cancer, mammary cyst, endometritis, lung cancer, liver cirrhosis, pancreatic cancer, cervical cancer, renal cyst, uterine anomaly, and post TAH state. In the remainder of false positive 156 cases, no abnormal findings were observed. Among 258 pateints who underwent combined tests of CA 125 and transvaginal ultrasound, the sensitivity of ovarian cancer was 100%. 5) The false positive rate was lower in the older age group (>50) than in the younger group (<50). CONCLUSION: The prevalance of ovarian cancer in our study was 0.0153% (15.3 per 100,000 population) which is comparable to the rate of 15.8 per 100,000 population reported by the Korean Medical Insurance Corporation. Although the CA 125 test by itself shows a low positive predictive value, its clinical usefulness as a screening test can be enhanced dramatically by the combined use of transvaginal ultrasound examination, especially in postmenopausal women.

Prediction of Residual Neoplasia Based on Pathologic Severity and Resection Margin Status of Conization Specimens / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate the status of cone margins and severity of cervical neoplasia as predictors of residual lesions in the remaining cervices, and provide guideline for further treatment or close follow-up. METHOD: We performed a 3-year retrospective study and reviewed 95 patients who had undergone cervical conization followed by subsequent hysterectomy. RESULT: The prevalence rates of positive cone margins were 33, 50, 44, 71 and 88% respectively in patients with cervical intraepithelial neoplasia(CIN)II, CIN III, cervical cancer stage Ia1, Ia2 and Ib1. The prevalence rates of positive residual lesions in postcone hy-sterectomy specimens were 0, 31, 19, 29 and 59% respectively in patient with CIN II, CIN III, cervical cancer Ia1, Ia2 and Ib1. Residual lesions were significantly more frequently found in patients with positive cone margins(51%) than in those with negative margins(4.8%). Positive predictive values of margin status for the presence of residual lesions were 0, 56, 36, 40 and 67% respectively. Negative predictive values of margin status for the absence of residual lesions were 100, 94, 94, 100 and 100% respectively. CONCLUSIONS: (1) The prevalence of positive cone margin and residual lesion increased with more severe cervical neoplasia. (2) Positive cone margins had significantly higher risks of residual lesion than negative cone margins. (3) Positive cone margin does not invariably indicate the presence of residual lesion. (4) Negative cone margin does not ensure the absence of residual lesion. Subsequent hysterectomy may be reserved for the patient with CIN III or cervix cancer having positive cone margin or invasive lesion, or the patient who is not reliable for continuous follow-up.

Contribution of Color Doppler Scoring System to Diagnosis of Ovarian Malignancy / 대한부인종양콜포스코피학회잡지

The purpose of this prospective study was to evaluate the diagnostic value of color Doppler scoring system in characterization of ovarian masses. We performed transabdominal or transvaginal color Doppler sonopaphy on 82 women with ovarian masses and analyzed the sonographic findings. Ovarian lesions were assessed by means of morphological and color Doppler scoring system by Kurjak. Tumors were characterized by ultrasonographic findings as benign or suspected of being malignant. Then the results of each scoring systems were correlated with histopathological findings. The results were as follows; Of 82 ovarian masses, 64 were benign lesions(13 mucinous cystadenomas, 16 endometriomas, 20 teratomas, 8 serous cystadenomas, and 13 other abnormalities), and 18 were malignant(12 cancers and 6 borderline tumors). The color Doppler scoring system was useful in distinguishing malignant from benign masses, with a sensitivity of 88.2%, compared with the morphological scoring system of 86.7%. The specificity of color Doppler and morphological scoring system were 95.4% and 92.5%, respectively. The sensitivity of combination of both scoring systems was 88.9%, with a specificity of 96.9%. In conclusion, color Doppler scoring system is a useful tool in predicting the malignancy of ovarian lesions especially combined with morphological scoring system.

The effects of pregnancy induced hypertension on the metabolism of fetal adrenal cortical steroid hormone and lipoprotein - cholesterol / 대한산부인과학회잡지

No abstract available.