Preconception infection and genetic counseling

Congenital malformations are a common cause of illness, handicapping conditions, and death. Errors of morphogenesis leading to congenital anomalies have many recognized causes, including specific single-gene mutations, chromosome imbalances, and the action of teratogenic agents. Most congenital anomalies, however, are of multifactorial origin, occurring by complex interactions between not yet well understood genetic and environmental factors. Two to six percent of the newborn babies worldwide, i.e., 3 to 9 million infants a year, suffer from major congenital anomalies and genetic diseases. However, a great deal of this misery could be avoided. In particular, preconception care is more important than prenatal care for prevention of congenital anomalies since as many as 30 percent of pregnant women begin traditional prenatal care in the second trimester (>13 weeks of gestation), which is after the period of maximal organogenesis. Women and their partners whose ethnic background, race, or personal or family history places them at increased risk of having a fetus with a genetic disease should receive appropriate counseling. Furthermore, certain laboratory tests of the infection status of couples may be helpful in assessing the risk for and preventing some complications during pregnancy. Preconception evaluation and appropriate counseling permits parents to make informed reproductive decisions and provides reassurance.

The clinical responses of uterine artery embolization to treat uterine leiomyoma for 3 years / 대한산부인과학회지

OBJECTIVE: The aim of our study is to evaluate the effect of uterine artery embolization as primary treatment for symptomatic uterine fibroid METHODS: From December 1999 to December 2004, 25 patients underwent uterine artery embolization for the treatment of uterine fibroid. The patients were followed up at regular intervals (at 1st, 3rd, 6th month and annual) for 3 years. The mean duration of follow-up was about 41 month (range; 41+/-15). During follow-up period, consecutive uterine and fibroid volume, and symptoms were checked. RESULTS: The uterine volumes were significantly reduced by 27% (P=0.0238) after 3month. And the fibroid volumes were significantly reduced by 59% (P=0.0070) after 1month. The uterine volumes were significantly reduced by 27% (P=0.0082) after 3 years. And the fibroid volumes were significantly reduced by 60% (P=0.0445) after 3 years. All women reported noticeable improvement of menorrhagia after complete of follow up. But, two of nine women who had symptoms of dysmenorrhea or lower abdominal pain, showed no changes in symptoms CONCLUSION: Uterine artery embolization appears to be effective in controlling symptoms, and substantially reducing uterine and fibroid volume with few complication after 3 years. However, long term follow-up will be necessary to establish the efficacy of this procedure.

Relationship between spontaneous preterm birth and polymorphisms of Interleukin-1beta and Interleukin-1 receptor antagonist in Korean women / 대한산부인과학회지

OBJECTIVE: Preterm birth is an important cause of infant death and morbidity but its pathophysiology still remains to be clear. The associations between preterm birth and the polymorphism of interleukin-1beta gene and interleukin-1 receptor antagonist gene have been suspected. And ethnic variations in the polymorphism of the genes were also reported. We decided to study polymorphisms of interleukin-1beta+3953 and interleukin-1 receptor antagonist in Korean pregnant women. METHODS: Patients were divided into 2 groups. Group 1 is the control group of 33 subjects with uncomplicated term delivery : group 2 is the case group of patients who had spontaneous preterm delivery. Polymorphisms were determined by polymerase chain reaction and restriction fragment length polymorphism analysis. RESULTS: There were significant differences in gestational age and birth weight between two groups (P<0.001). No significant differences were found in genotypic frequencies and allelic frequencies in interleukin-1beta+3953 between two groups. Interleukin-1 receptor antagonist gene had 5 alleles and the most frequent allele was IL1RN*1 (410bp), 66.7% in control group and 77.8% in case group. And significant differences were not found in genotypic frequencies and allelic frequencies between two groups, too. CONCLUSION: There were no significant differences in polymorphisms in interleukin-1beta +3953 and interleukin-1 receptor antagonist between term delivery group and preterm birth group.

Laparoscopic Partial Nephrectomy for the 4cm or Less Renal Tumors / 대한비뇨기과학회지

PURPOSE: The popularity of a partial nephrectomy has grown as a consequence of the increased detection of small incidental renal masses. Herein, our experience of laparoscopic partial nephrectomies is reported. MATERIAL AND METHODS: Between December 2003 and April 2006, 27 cases underwent a laparoscopic partial nephrectomy for renal tumors up to 4cm in diameter. The tumors, and an approximate 0.5cm margin around the tumors, were resected with cold scissors. Hemostasis was achieved with freehand suturing of the pelvocalyceal system and renal parenchyme, over the surgical bolster, using fibrin glue. RESULTS: Transperitoneal and retroperitoneal approaches were chosen in 14 and 13 cases, respectively. Hilar clamping of small exophytic tumors was performed in all but 3 cases, with minimal parenchymal invasion. The mean renal tumor size was 2.5cm (ranging from 1 to 4cm). The mean operative and warm ischemia times, and blood loss were 193 minutes (ranging from 115 to 300) and 27.8 minutes (ranging from 15 to 43), and 493ml (ranging from 32 to 1,248), respectively. The mean hospitalization stay was 5.2 days (ranging from 3 to 8 days). Conversion to a laparoscopic radical nephrectomy was required in one case due to a positive frozen biopsy of the resection bed. There were no perioperative complications or open conversions. Histological examinations yielded a renal cell carcinoma in 20 cases, an angiomyolipoma or oncocytoma in 2 cases each, a lipoma in 1 and a leiomyosarcom in 2 cases, two of which had positive margins. One patient underwent selective angioembolization for an asymptomatic renal artery pseudoaneurysm three months postoperatively. All patients were alive, without any local recurrence or metastatic disease, at a mean follow up of 11.4 months (ranging from 3 to 24 months). CONCLUSIONS: A laparoscopic partial nephrectomy can be performed safely. However, long-term follow-up is required to compare its cancer control with that of an open partial nephrectomy.

Well Differentiated Papillary Mesothelioma of the Ovarian Surface: A Case Report

Well differentiated papillary mesothelioma (WDPM) is an unusual variant of epithelial mesothelioma. Most WDPMs exhibit either benign or indolent behavior. Making the differential diagnosis between this rare tumor and serous papillary carcinoma can be problematic. We report here on a case of a 43-year-old woman with a WDPM of the surface. She presented to our hospital for a routine gynecologic evaluation, and she had no specific symptoms or a history of asbestos exposure. Gynecologic ultrasonography revealed a right ovarian mass that measured 6 x 3.8 x 3 cm in size. No ascites was detected. Right salpingo-oophorectomy was performed; grossly, the tumor was a yellowish firm, multinodular mass. Microscopically, the tumor consisted of numerous papillae that were lined by a single layer of uniform mesothelial cells. Nuclear pleomorphism and mitoses were not found. On immunohistochemical study, the tumor cells were positive for calretinin and cytokeratin, but they were negative for CEA. It is important to differentiate WDPM from serous papillary carcinoma or other malignant tumors to avoid treating them as malignant tumors.

Effectiveness of Doxycycline as Monotherapy for the Treatment of Acute Pelvic Inflammatory Disease resistant with Traditional Combined Regimen / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of doxycycline as monotherapy for the treatment of acute pelvic inflammatory disease (AcPID) resistant with traditional combined regimen (TCR). METHODS: 128 patients were selected, who were diagnosed as AcPID from January 2003 to June 2004 and prescribed with medical treatment. Initially, TCR by cephalosporin, metronidazole, and aminoglycoside antibiotics was applied to all patients. 2-3 days later, the level of subjective pain or tenderness on pelvic examination was evaluated. If it is 30% or less than initial symptoms and signs, original regimen was prescribed (group I). If it is 30% more than initial symptoms and signs, we judged AcPID resistant with TCR and changed the antibiotic regimen with doxycycline (group II). Cure of AcPID was defined by no pain or tenderness. In this study, retrospective review about the result of medical treatment and clinical characteristics between two groups was done. RESULTS: Of the 128 patients, 94 (73.4%) was group I (46 inpatient and 48 outpatient) and 34 (26.6%) was group II (20 and 14). There were no significant differences in clinical characteristics except initial blood WBC count between group I and II. Initial blood WBC count was 11153+/-4393/microliter in group I and 9112+/-3483/microliter in group II (p<0.05). Positive rate of Chlamydia trachomatis using PCR was 9.4% (12/128) in all patients (group I:0%, II:35.3%). All patients of two groups were cured with TCR and doxycycline. CONCLUSION: Our data shows that doxycycline as monotherapy is effective to patients who are resistant with TCR for medical treatment of AcPID.

Leptin and growth hormone in the cord blood of healthy neonates: correlation with fetal growth / 대한산부인과학회지

OBJECTIVE: To understand the correlation between leptin in cord blood and parameters indicating fetal growth and to investigate the relationship between leptin and growth hormone. METHODS: We measured leptin and growth hormone levels in the cord blood of 46 healthy neonates by radioimmunoassay (RIA), and analyzed the correlation of leptin with growth hormone, birth weight, gestational age, sex, birth height, body mass index, maternal body mass index (BMI), and Ponderal Index by Pearson correlation coefficients. RESULTS: Leptin concentration of cord blood was 5.16 g/l in median value; concentration in female cord blood was significantly higher than in male's (P=0.005). Growth hormone concentration was 28.60 g/l; there was no significant difference between female and male (P=0.584). There were significant correlations between leptin and birth weight, birth height, and BMI at birth, with correlation coefficients 0.56 (P=0.0001), 0.35 (P=0.017), and 0.35 (P=0.017), respectively. Growth hormone was correlated with leptin but statistically insignificant (P=0.085). And growth hormone was not correlated with gestational age, Ponderal Index or maternal BMI. CONCLUSION: Leptin is significantly correlated with fetal growth, and growth hormone is potentially correlated with fetal growth.

Spontaneous Uterine Rupture in the First Trimester: A Case Report

Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. Most of the cases have various risk factors and mainly occur during the second or third trimester. However, spontaneous uterine rupture during the first trimester is extremely rare. We experienced a case of spontaneous uterine rupture in a 36-yr-old multiparous woman without definite risk factors. The initial impression was a hemoperitoneum of an unknown origin with normal early pregnancy. Intensive surgical method would be needed for accurate diagnosis and immediate management in bad situation by hemoperitoneum even though a patient was early pregnancy.

A Case of Prenatally Detected Concomitant Hydrocephalus and Anencephaly in Twin Pregnancy / 대한산부인과학회지

Multiple gestation accounts for 1 percent of all pregnancies. But, the morbidity of congenital anomaly is more than 2 times in contrast to singleton gestation. The major congenital anomaly was developed about 2 percent in the multiple gestation. Hydrocephalus and anencephaly, known central nervous system anomaly, were seen about 0.1% each other in singleton gestation. We have experienced a case of prenatally detected concomitant hydrocephalus and anencephaly in twin pregnancy which was diagnosed by ultrasonography at 16 weeks gestation. Thus, we report a case with brief review of the literature.

A Case of Pelvic and Abdominal Wall Actinomycosis / 대한산부인과학회지

Actinomyces species are gram-positive, non-acid fast anaerobic bacteria that exhibit branching, filamentous growth. More recently, It reported that female genital actinomycosis has been associated with the use of an intrauterine contraceptive device (IUD). We have experienced a case of pelvic and abdominal wall actinomycosis with mucinous cystadenoma in a 36-years-old woman using IUD and report it with brief review of literature.

Vaso-cutaneous Fistula after Vasectomy / 대한비뇨기과학회지

A vasectomy is a safe and effective method of sterilization for men, with a low complication rate. Typical complications of a vasectomy include: wound infection, scrotal hematoma, epididymitis and sperm granuloma. However, vaso-cutaneous fistulae after a vasectomy are extremely rare. Herein is reported a case of a vaso-cutaneous fistula after a vasectomy for the sterilization of a 35-year-old man.

Vaso-cutaneous Fistula after Vasectomy / 대한비뇨기과학회지

A vasectomy is a safe and effective method of sterilization for men, with a low complication rate. Typical complications of a vasectomy include: wound infection, scrotal hematoma, epididymitis and sperm granuloma. However, vaso-cutaneous fistulae after a vasectomy are extremely rare. Herein is reported a case of a vaso-cutaneous fistula after a vasectomy for the sterilization of a 35-year-old man.

Clinical Results of Microsurgical Anterior Foraminotomy for Cervical Radiculopathy

OBJECTIVE: The authors present the clinical and radiologic outcomes of microsurgical anterior foraminotomy in 36 cases of cervival radiculopathy. METHODS: Thirty-six patients were treated with anterior cervical foraminotomy between January 1998 and June 2002. There were 13 men and 23 women(age range, 34-74 years). Twenty-nine had symptomatic soft disc herniation and 7 had uncovertebral osteophytes confirmed by magnetic resonance imaging and computed tomography. Thirty-one patients had single anterior cervical microforaminotomy and five had procedures at adjacent levels. RESULTS: Good or excellent result were obtained in 75% of the patients. On roentgenographic examination, the height of intervertebral space was maintained at twenty-one levels(51%) and was decreased at seventeen levels(42%). Two patients who underwent anterior cervical microforaminotomy developed kyphosis of the cervical spine and one patient developed instability of the cervical spine. CONCLUSION: Anterior cervical foraminotomy appears to be a good alternative procedure for carefully selected patients with unilateral cervical radiculopathy and avoids a fusion of the disc space.

A Study of Ovarian Dysfunction after Chemotherapy in Cancer Survivals / 대한산부인과학회잡지

OBJECTIVE: We analysed the duration of ovarian dysfunction, amenorrhea and pregnancy rate of the patients who underwent the fertility preserving surgery and adjuvant chemotherapy at the reproductive age to identify the contributing factors of ovarian dysfunction and premature menopause. METHODS: We select the 25 patients (<40 years old at diagnosis) among the 270 patients with malignant ovarian tumor who undergone conservative surgery and platinum-based adjuvant chemotherapy between the year 1985 and 2001. All patient was disease free state. Method used for follow up were physical exam, tumor markers and ultrasonography. We analysed age at diagnosis, amenorrheic period, recovery of ovarian function whether hormonal agent was used or not, times of pregnancy, times of successful pregnancy, and times of pregnancy outcome with anomaly. RESULTS: In 25 cases, patients who became pregnant had a shorter period of amenorrhea of 2.55 months compared to 20.47 months of the rest. Total times (Kur) of chemotherapy shows no difference between two groups (6.45 vs 6.33). Average age show no differences between two groups (22.43 years vs 22.9 years), but amenorrheic period increased in proportion to age at treatment and times of chemotheapy, so we can guess that ovarian dysfunction is more serious with higher age at diagnosis and many times of chemotherapy. In the group who had been pregnant, successful outcome were 7 of 9 total times of pregnancy (abortion rate was 22%), and no baby had gross anomaly. CONCLUSION: So we can guess that ovarian dysfunction is more serious with higher age at diagnosis and more times of chemotherapy.

Effects of progesterone/progestin on the apoptosis of the human umbilical vein endothelial cell / 대한산부인과학회잡지

OBJECTIVE: The addition of progesterone/progestin is mandatory in women with intact uterus for postmenopausal hormone replacement therapy. However, debate is continuing on whether there is an impact of progesterone/progestin on the hormone replacement therapy for cardiac protection. The aim of this study was to investigate the effect of progesterone/progestin and combination with estrogen on the apoptosis of vascular endothelial cells, which has been demonstrated to be an initial step in the development of atherosclerosis. MATERIAL AND METHODS: Human Umbilical Vein Endothelial Cells (HUVEC) were cultured. HUVEC apoptosis was induced by Tumor Necrosis Factor-alpha (TNF-alpha) (50 ng/ml). 10-7M of estradiol (E2), progesterone (P4), medroxyprogesterone acetate (MPA) and norethindrone acetate (NETA) were added in to the culture media. The percentage of apoptotic HUVEC were measured by 3-[4,5-Dimethylthiazol-2-yl]-2,5- diphenyltetrazolium bromide (MTT) assay and Fluorescence Activated Cell Sorting (FACS) analysis. RESULTS: MTT assay demonstrated a significant decrease in percent of survival cells after 24 hours of TNF-alpha exposure and a reversal of the effect of TNF-alpha with E2 treatment. P4, MPA and NETA treatment also reversed the effect of TNF-alpha. The protective effect of E2 and P4 were not different. Compared to the E2 treatment, the percent of survival cell were decreased when P4, MPA and NETA were added to E2 treatment, respectively. Similarly, FACS analysis revealed 44.0+/-2.6% apoptosis after 24 hours of TNF-alpha exposure. Treatment with E2 resulted a significant decrease (28.4+/-2.9%, P<0.05) in apoptosis. P4 (33.6%+/-2.6%, P<0.05), MPA (35.7+/-1.3%, P<0.05), NETA (34.0+/-3.3%, P<0.05) treatment also showed a reduction of cell death. The percent of apoptotic cells between E2 and MPA treatment was significantly different. The addition of P4 (36.0+/-2.5%), MPA (36.3+/-1.9%) and NETA (37.0+/-2.0%) to E2 treatment significantly increased the percent of apoptotic cells compared to those of E2 treatment. CONCLUSION: These results suggested that not only estradiol, but also progesterone, MPA and NETA inhibited HUVEC apoptosis. But the effect of estrogen on the inhibition of HUVEC apoptosis was attenuated in combination treatment of estrogen and progesterone/progestin.

The Clinical Outcome of Epidural Analgesia on Labor and Delivery of Nulliparous Women / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the effect of epidural analgesia on the first phase of labor and mode of delivery of nulliparous women. METHODS: We studied 170 nulliparous women at near-term who underwent spontaneous and induced labor at the Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1999 to May 2000 prospectively. Eighty women who were received epidural analgesia for pain relief were compared to ninety women as control group. Cesarean delivery was performed when indicated. RESULTS: The demographic characteristics of the two groups were similar with respect to age, height, weight, gestational weeks, and gravida. The two groups had the same cervical dilatation at the time of analgesia. There were no statistically significant difference between two groups. The length of the first phase of labor was same between two groups(558.4+/-50.4 min. vs 452.1+/-46.7 min.). There were statistically significant differences in the instrument delivery and cesarean section rate between two groups(43 vs. 32, 8 vs. 16 respectively). CONCLUSIONS: Epidural analgesia provides safe and effective intrapartum pain control and may be administered without undesirable effects on the first phase of labor and delivery.

A case of multicystic encephalomalacia in a surviving twin after intrauterine death of co-twin / 대한산부인과학회잡지

The antepartum death of a fetus in a twin pregnancy may cause significant risk of mortality and morbidity in the surviving infant. Especially, one fetal demise of a twin pregnancy in the second or third trimester is an uncommon and difficult problem in the management of pregnancy. In this report, we present a case of single intrauterine death in a twin gestation diagnosed in the 27th week of pregnancy and the surviving fetus exhibits multicystic encephalomalacia three weeks later, antenatally.

Preoperative Uterine Artery Embolization and Evacuation in the Management of Cervical Pregnancy: Report of Two Cases

Preoperative uterine artery embolization and cervical evacuation as conservative management of cervical pregnancy has been tried in recent years. However, cervical suturing, vasoconstrictor injection, or cervical ballooning was frequently used as an ancillary measures in those procedures in most of the previous studies. We report two cases of cervical pregnancy that were successfully treated with preoperative uterine artery embolization and removal of gestational material without ancillary procedures. Our therapeutic modality seems to be safe and effective for conservative management of cervical pregnancy.

A case of preoperative angiographic uterine artery embolization for the conservative treatment of cervical pregnancy / 대한산부인과학회잡지

A 35 year old woman, gravid 5, multiparous, was admitted to our department at 6 weeks and 5 days of gestation after being diagnosed with cervical pregnancy. Before the evacuation, the uterine arteries were embolized using angiographic techniques. As a result, dilatation and curettage were performed with minimal hemorrhage. We report one case of cervical pregnancy managed, successfully with preoperative uterine artery embolization and evacuation.

Endometrial and Corporal Extension in Carcinoma of Uterine Cervix / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The objective of this study was to evaluate clinical significance of endometrial and corporal extensions of Carcinoma of the uterine cervix. METHODS: The 273 patients with locally advanced cervical cancer who underwent radical hysterectomy after neoadjuvant chemotherapy between Jan 1983 to May 1998 were included in this study and endometrial and corporal extension was examined by pathologic report. Then, clinical characteristics such as age, stage, tumor size, geographic contour, the lymph node and parametrial invasions, recurrence rate, and 5 year-survival rate were compared between extension(n=30) and non-extension(n=243) group. Pearson chi-square test, Fisher's exact test, and Kaplan-mayer survival analysis were used for calculation of statistical significance between two group. p-value less than 0.05 was considered to be clinically significant. RESULTS: The incidence of endometrial and corporal extension in this locally advanced cervical cancer group was 11% (30/273). The endometrial and corporal extension were closely related with advanced stage, larger cervical tumor mass, endophytic type, and pelvic lymph node metastasis. However, 5-year disease free survival rates or 5-year actuarial survival rates did not show statistically significant differences between extension and non-extension group (7S% vs 83% and 81% vs 84%, respectively) CONCLUSION: The endometrial and corporal extension were closely associated to high risk factors of advanced cervical cancer. Though its clinical significance for poor outcome were not proved in this study, prospective study with more patients is needed to clarify its clinical significance.