Expression of mullerian inhibiting substance and its receptor in ovarian neoplsia / 대한산부인과학회지

Mullerian inhibiting substance (MIS) is a glycoprotein hormone produced by fetal Sertoli cells that causes regression of the Mullerian ducts in males during sexual differentiation. Cell lines derived from human ovarian epithelium and rodent Leydig cell tumors, which respond to MIS in growth inhibition assays and express the MIS type II receptors (MISR II). But the pathophysiological role of MIS in human ovarian neoplasia development has not yet been fully established. In order to understand its role in pathogenesis of ovarian neoplasia, the expression and localization of the MIS and MISR II were studied in 5 normal ovaries, 11 benign tumors, 9 borderline ovarian malignancies, 40 ovarian malignancies in paraffin embedded tissue and tissue microarrays by using immunohistochemical stain. The results were as follows; 1. The first staining for MIS and MISR II were detected in granulosa cells in primary follicles of normal ovary. Among the growing follicles, larger developing follicles stained more intensely than smaller follicles. 2. In benign ovarian tumors, 8 (72.73%) in MIS and 5 (45.45%) in MISR II out of 11 cases were stained. The intensity scores of staining were 1.18 in MIS and 0.64 in MISR II. 3. In borderline malignancies, 6 (66.67%) in MIS and 7 (77.78%) in MISR II out of 9 cases were stained. The intensity scores of staining were 0.89 in MIS and 1.22 in MISR II. 4. In ovarian malignancies, the expression of MIS and MISR II were 50% (9/18) and 50% (9/18) in epithelial, 92.30% (12/13) and 76.72% (10/13) in germ cell, and 88.9% (8/9) and 100% (9/9) in sex-cord stromal tumors. The intensity scores of MIS and MISR II expression were 0.72 and 0.72 in epithelial, 1.45 and 1.62 in germ cell, and 1.78 and 1.67 in sex-cord stromal tumors. 5. There was significant high expression of MIS and MISR II in non-epithelial (90.91%, 86.36%) than epithelial ovarian cancers (50%, 50%). The scores of expression intensity was also higher in non-elithelial cancers (MIS: 1.67 +/- 0.16 vs 0.72 +/- 0.20, p=0.003, MISR II: 1.64 +/- 0.20 vs 0.72 +/- 0.21, p=0.022). In conlusion, the expression of MIS and MISR II were not different according to the differentiation, but tissue type specific. The frequency of MIS and MISR II expression was higher in non-epithelial cancers, especially in sex-cord stromal tumors. The results of this experiment could be utilized as scientific basis of researches, furthermore clinical applications in diagnosis and treatment of non-epithelial ovarian malignancies.

Prevalence of Chlamydia Trachomatis and Relation with Human Papilloma Virus / 대한산부인과학회잡지

OBJECTIVE: One of the most common causative microorganisms in pelvic inflammatory disease (PID) is the chlamydia trachomatis. In many cases chlamydia trachomatis infection has weak and nearly absent symptom, but it's endocervical infection usually disseminates into upper genital tract. In this infection tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic infection has involved. In this study, we investigated the prevalance of chlamydia trochoma infections in symptomatic and asymptomatic women and its relation with Human Papilloma infection. METHODS: From Jan, 1999 to July, 2003, in St. Vincet's Hospital, The Catholic University of Korea, endocervial swabs were obtained in 3416 patients (1137 in Heath Promotion Center, 2226 in OPD) by Amplicor Chlamydia Trahomatis Kits (STD swab specimen collection transprt kits). Chlamydia trachomatis DNA was extracted and amplified by PCR assays to investigate the prevalence. Also in this study we investigated the prevalence of human papilloma virus by hybrid capture method. Women who visted Hospital were received routine gynecologic examination, history taking, and physical examination and information on potential risk factors was obtained by questionnaire. RESULTS: The prevalence rate of Chlamydia trachomatis in symptomatic women was 12.6% and there was a high peak prevalence among the early twenties (66%). The prevalence rate of Chlamydia in asymtomatic women was 8.2% but there was no peak in early twenties. In asymptomatic woman, asymptomatic chlamydia infection can be statistically anticipated by 1) Economic status, 2) Occupation status, 3) Alcohol intake, 4) History of Gynecologic disease, 5) History of STD. Women with chlamydia infection was 1.5 times greater risk of coincidal HPV infection and was statistically significant. CONCLUSION: The prevalence rate of chlamydia infection is higher than any other developed country, especially in asymptomatic women. Although symptoms are weak, the rate of prevalence and complications can be reduced by the screening of chlamydial infection.

Patterns of Hyrtl's Anastomosis and their Effects on Obstetric Outcomes / 대한산부인과학회잡지

OBJECTIVE: This study was conducted to investigate the presence and pattern of Hyrtl anastomosis, and to examine the effect that each type has on obstetrical outcome. METHODS: This study was carried out from January of 2001 to May of 2003 on 904 randomly selected patients who had given birth by Cesarean section or vaginal delivery at Catholic University Holy Family Hospital. Immediately proceeding delivery, barium sulfate was infused into the umbilical artery. This was followed by umbilical artery dissection to grossly confirm Hyrtl anastomosis. In order to evaluate the effect that each type of anastomosis has on obstetrical outcome, we retrospectively examined chart for birth weight, Apgar score, results of cord blood gas analysis, obstetrical complications, etc. RESULTS: Out of the 904 cases studied, 99.7% possessed Hyrt's anastomosis with frequency according to type as follows: 50.8% oblique, 48.0% transverse, 1.8% of anastomosis between one umbilical artery and the branch of the other, 1.6% of fusion of branches of each umbilical artery, 0.6% of anastomosis represented by two separate vessels between umbilical arteries, 0.1% of anastomosis between branches of each umbilical artery, 0.1% lacking anastomosis, and 0.2% of a single umbilical artery. In terms of obstetrical outcome, there was no significant difference for term and preterm infants in the frequency of type of Hyrtl's anastomosis according to birth weight, maternal age, Apgar score, obstetrical complications, etc. CONCLUSION: In an attempt to verify the presence and type of Hyrtl anastomosis, 8 types of Hyrtl's anastomosis were found, of which the oblique and transverse variety were the most common. There was no significant difference in the types of Hyrtl's anastomosis in relation to obstetrical outcome. Frequency was also similar with oblique and transverse types being the most common. Further studies detailing anatomical features of and blood flow/volume through the anastomosis are required in order to better understand the effects of Hyrtl's anastomosis on obstetrical outcome.

Clinical Course of The Patient who Had the Gynecologic Operation Using Minilaparotomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical course of the patient who had the gynecologic operation using minolaparotomy. METHODS: We reviewed the chart of the patient who had the gynecologic operation using minilaparotomy in department of obstetrics and gynecology of St. Mary's hospital during Jan. 2000 Sept. 2002. RESULTS: Postopertive diagnosis is myoma (154 cases), adenomyosis (41 cases), ovary cyst (89 cases) and so on. We had performed hysterectomy (225 cases), myomectomy (86 cases), cystectomy or adenexectomy (85 cases) for these patient. There is no significant difference in clinical course between two total hysterecomized groups, one who had the operation history and the other who had not the operation history. CONCLUSION: In gynecological operations, minilaparotomy is the useful methods in any kind of the indication of operation, and show good clinical course.