Evaluation of the Antenatal Fetal Brain Metabolites using Proton Magnetic Resonance Spectroscopy / 대한주산의학회잡지

OBJECTIVE:The purpose of this study was to compare the sensitivity of proton Magnetic Resonance Spectrography (MRS) for estimating absolute metabolite concentrations and ratio of fetal brains. METHODS:Between September 2005 and August 2006, our study was prospective single center trial and included 39 healthy women (Group 1: fetuses with risk factor of fetal distress or hypoxic damage [n=15], Group 2: fetal CNS anomalies on ultrasound [n=12], Group 3: normal fetuses [n=12]). We quantified resonances for the main proton MRS-detectable brain and calculated metabolite ratios of the three groups. We compared the obtained metabolite levels of the three groups with electronic fetal cardiotocography, Doppler ultrasound examination, Apgar score, and umbilical artery blood gas analysis. RESULTS:Abnormal amniotic fluid, abnormal Doppler studies, and abnormal cardiotocograms were significantly more prevalent in Group 1 compared with those of Group 2 and 3. In Group 1, choline (Cho) levels (7.86+/-3.51mmol/L) were significantly higher than in Group 2 or 3 (p=0.024). The ratios of N-acetylasparate (NAA)/creatinine-phosphocreatine (Cr) and Cho/Cr were increased whereas the ratios of NAA/Cho, lactate (Lac)/Cho, Lac/NAA, and Lac/Cr were decreased; however, there was no statistical significance. In patients who have oligohydramnios and absence of umbilical diastolic flow, choline and N-acetylasparate levels were significantly elevated (p<0.05, p<0.05, respectively). But, MRS metabolites and ratios showed no significant differences for low Apgar scores, umbilical arterial academia, uterine artery notching, maternal blood pressure or abnormal fetal cardiotocograms. CONCLUSION:This study demonstrates the possibility of performing proton MRS to assess the metabolic information of the fetal brain. Further technical progress may be useful of improving the degree of detection of hypoxic changes or an impending hypoxic state for prenatal diagnosis.

Proportion of CD4+CD25+ regulatory T lymphocyte in peripheral blood of patients with gynecologic cancer / 대한산부인과학회지

OBJECTIVE: Recently the existence of a CD4+CD25+ regulatory (Treg) population has been described in rodents and humans. It is unclear how the immune response cells interact to tumor cells effectively, but the malignant tumor cell growth was suppressed by the main effect of T lymphocytes and natural killer cells in experimental studies using various biologic response modifier. This study was performed to investigate the proportion of CD4+CD25high Tregs and expression of Foxp3 in Peripheral blood (PBL)s in patients with cervical, ovarian or uterine cancers. METHODS: Blood samples were collected from 10 healthy women and a total of 40 patients with gynecologic cancer at department of Obstetrics and Gynecology, Asan Medical Center, Seoul, Korea, from March 2005 to September 2005, were enrolled in study group. Information regarding patient history and tumor stage was recorded. They were diagnosed at same center at first, and never been treated any therapy. The population of CD4+CD25+high Tregs as a percentage of total CD4+cells was evaluated by flow cytometric analysis. We measured the proportion of Treg cell that co-express CD4 and CD25 in the peripheral blood lymphocytes form patients with either cervical, ovarian uterine cancer or carcinoma in situ of cervix. Expression of Foxp3 in the CD4+subsets defined by electrophoresis. RESULTS: The following tumor entities were included cervical cancer (n=10. 7 in stage I, 1 in stage II, 1 in stage III, 1 in stage IV); ovarian cancer (n=10. 4 in stage I, 0 in stage II, 5 in stage III, 1 in stage IV), ; uterine cancer (n=10. 9 in stage I, 0 in stage II, 0 in stage III, 1 in stage IV). In cervical cancer patient, ovarian cancer patients, uterine cancer patients and healthy women, the proportion of CD4+CD25high Tregs was 4.53% (SD 2.30), 6.89% (SD 7.81), 4.37% (SD 2.43) and 0.87% (SD 0.57) of the total CD4+cells respectively. The proportion of CD4+CD25+high T cells was significantly higher in cervical cancer patients (p=0.016), ovarian cancer patients (p=0.001) and uterine cancer patients (p=0.038) when compared with healthy women. But there was no significant difference in proportion of CD4+CD25+ Tregs comparing with healthy women. Expression of Foxp3 was significantly thicker in tumor-associated lymphocytes than control T cells by electrophoresis. CONCLUSION: In conclusion, our data suggested that the increase in frequency of regulatory T cells might play a role in modulation of the immune response against cervical, ovarian, uterine cancer could be important in design of immunotherapeutic approaches.

Overview for the management of preterm labor / 대한산부인과학회지

Premature labor remains one of the most intractable risk factors that contribute to perinatal morbidity and mortality. Tocolytics, antibiotics and corticosteroid have been used as the typical management for preterm labor. Various treatment of women with signs and symptoms of preterm labor has failed to decrease in the incidence of preterm births in the world. The management of preterm labor remains very controversial problems today. There are no clear "first-line" tocolytic drugs and antibiotics to prolong gestation period and improve perinatal outcome. But in Royal College of Obstetricians and gynecologists (RCOG) recommend that atosiban and nifedipine appear to be preferable as they have fewer side effects and seem to comparable effectiveness. So far there is insufficient evidence for any firm conclusions about whether or not maintenance tocolytic therapy following preterm labor is valuable. In conclusion, clinical circumstances and physician preferences should dictate treatment. Individual approach or combined treatment for preterm labor may be helpful in determining which treatment is suitable to each patient.

Clinical Analysis of 23 Cases of Endometrial Stromal Sarcoma / 대한산부인과학회지

OBJECTIVE: The aim of this retrospective study was to evaluate the survival, recurrence and prognostic factors of endometrial stromal sarcoma (ESS). METHODS: Twenty three patients who had diagnosed with ESS and managed between June 1989 and December 2004 were included. Clinicopathologic characteristics were evaluated including age, parity, menopause, stage, grade, type of surgery, adjuvant therapy, overall survival, disease free survival. RESULTS: The mean age of the group was 44 years. Eighty two percents of patients were premenopause and the most common symptom was vaginal bleeding. Thirteen patients were in stage I and four patients were in stage II and III. Six patients were not able to determine the stage. Eighteen patients were low grade ESS and five patients were high grade. The median overall survival was 179 months and the median disease free survival was 134 months. Disease had recurred in 6 patients and 2 patients died of the disease. Higher tumor grade was associated with lower overall survival (P=0.047) and disease free survival (P=0.035). CONCLUSION: The prognostic factor of ESS is tumor grade.

Malignant Mixed Mullerian tumors of the ovary: The result of Platinum-based combination chemotherapy following the cytoreductive surgery / 부인종양

OBJECTIVE: The purpose of this study was to review the therapeutic results and the clinical outcome of the patients treated with optimal cytoreductive surgery and platinum-based chemotherapy for malignant mixed mullerian tumors (MMMTs) of the ovary. The evaluate the role of such treatments in ovarian MMMTs. METHODS: A retrospective analysis was performed with medical records that nine patients underwent complete surgical staging from February 1993 to January 2004 at Asan Medical Center, Korea. Seven patients received IP (ifosfamide/cisplatin) chemotherapy as a first-line chemotherapy and the other patients received other platinum-based combination chemotherapy. Demographic data, pathologic findings, treatment and survival time were studied. RESULTS: Nine patients diagnosed with MMMTs of the ovary after optimal cytoreductive surgery. The International Federation of Gynecology and Obstetrics stages for the 9 women were none stage I, 1 stage II, 6 stage III, 2 stage IV. The median survival time of all patients was 41 months (1-76 months). The overall survival rate was 55.5% at 1 year and 40% at 2 years. CONCLUSION: Malignant mixed mullerian tumors of the ovary grow very rapidly and are usually in advanced stages when diagnosed. But our results of clinical experience for platinum-based combination chemotherapy after optimal cytoreductive surgery could be a standard treatment for ovarian MMMTs.