Differential gene expression of transglutaminase 2 in term pregnancy with and without labor / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate transglutaminase 2 (TGM2) mRNA and protein expressions in term placentas and fetal membranes delivered with labor compared to no labor. METHODS: Samples were obtained from five cases delivered with labor and five cases delivered without labor after 38 weeks of gestation. Each sample was collected from amnion, chorion, central and peripheral portion of the basal plate of placenta. Real time polymerase chain reaction (RT-PCR) was done to analyze mRNA expression of TGM2. Western blot was done and TGM2 protein level was detected. Mann-Whitney U test was used for statistic analysis. RESULTS: In labor group, TGM2 mRNA expressions were decreased compared to no labor group in 3 sampling sites except chorion (0.66+/-0.10 vs 1.29+/-0.12 in peripheral placenta, 0.67+/-0.23 vs 1.02+/-0.02 in central placenta, 0.70+/-0.16 vs 1.04+/-0.05 in amnion in contrast with 1.62+/-0.64 vs 1.56+/-0.21 in chorion). TGM2 protein expressions of four differential portions were decreased in all labor groups (1.05+/-0.35 vs 1.27+/-0.19 in peripheral placenta, 0.69+/-0.84 vs 0.84+/-0.31 in central placenta, 0.33+/-0.15 vs 0.39+/-0.33 in amnion, 0.96+/-0.18 vs 1.77+/-0.61 in chorion). CONCLUSIONS: This result suggests that TGM2 might involve in labor progress of term pregnancy.

A Clinical Study of Maternal Heart Disease in Pregnancy / 대한주산의학회잡지

OBJECTIVE:To assess the pregnancy outcomes complicated by maternal heart diseases. METHODS:From 1995 to 2006, medical records of pregnant women who had received full antenatal care at Kangnam St. Marys Hospital and Our Lady of Mercy Hospital with maternal heart diseases were reviewed. RESULTS:Forty one deliveries from 39 women were enrolled for analysis. 11 (26.7%) cases of the heart diseases were of rheumatic origin, 22 (53.7%) cases had arrhythmic disease, 3 (7.3%) cases had congenital heart disease, and the remaining 5 (12.3%) cases were consisted of miscellaneous diseases such as ischemic heart disease and congestive heart failure. There were 4 (9.8%) cases of pulmonary edema which had occurred as maternal complication during pregnancy. One case was a twin pregnancy. All of them were in New York Heart Association (NYHA) functional classes I, II before, during, and after delivery. Mean gestational age at birth and birth weight were 38.6 weeks and 3,157 g respectively. Neonatal congenital heart disease was shown in only one case with tetralogy of Falot and the other fetal anomaly was multicystic dysplastic kidney. CONCLUSION:Our results indicate that successful pregnancy outcome in patients with maternal heart disease would be possible in NYHA functional classes of I and II without any increased risk of complications.

Differential Gene Expression in Placenta of Term Pregnant Women with and without Labor using cDNA Microarray / 대한주산의학회잡지

OBJECTIVE:cDNA microarray technology was used to comprehensively analyze the gene expression in the placenta of term women with labor compared to without labor. METHODS:Placental tissue was obtained from patients in spontaneous labor (n=5) and those not in labor (n=5) during Cesarean section of full term pregnancy. mRNA levels were examined through cDNA microarray using Agilent GeneSpringGX 7.3 (Agilent technology, USA). SPSS 11.0 was used for statistical analysis. RESULTS:Among total 38,467 genes, 2,374 genes were detected to be up-regulated in labor samples, while 12 genes were down-regulated. 40 genes of them were identified as significantly up-regulated in levels of expression (up-regulated > or =5.0 fold, p<0.05). According to gene ontology analysis, they are associated with variable cell biologic functions including apoptosis, signal transduction, metabolic process, immune response, and transcription, etc. CONCLUSION:This study suggests that our results could provide interesting clues to understanding the initiation and the process of normal labor and might lead to further studies in a more targeted fashion.

The effect of lymphadenectomy on the survival rate of clinical stage I endometrial cancer / 부인종양

OBJECTIVE: To evaluation of the effect of pelvic or paraaortic lymphadenectomy on survival rates in the management of clinical stage I endometrial cancer METHODS: A retrospective analysis was performed on a total 303 clinical stage I endometrial cancer patients from 1989 to 2004 at Asan Medical Center. Two hundred-sixty-three (86.8%) underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic or paraaortic lymphadenectomy, while forty (13.2%) underwent a total hysterectomy and bilateral salpingo-oophorectomy only. Characteristics of patients and 5-year survival rate of each patients group were analyzed. RESULTS: Seventeen (6.5%) showed lymph node metastases and overall 5-year survival rate of clinical stage I endometrial cancer was 96.9%. The 5-year and 10-year survival rate of a group with lymphadenectomy were 96.4% and 86.6%, and those of a group without lymphadenectomy were 100% and 75.2%, respectively (p=0.48). The 5-year survival rate of a group with positive lymph nodes was 73.3%, that of a group with negative lymph nodes was 97.7% (p<0.05). CONCLUSION: The complete staging operation including lymphadenectomy did not improve the survival rates in a group with lymphadenectomy significantly. But the debates regarding the necessarity of lymphadenectomy in clinical stage I endometrial cancer still remains and a large randomized prospective study is needed.

A case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of bilateral ovary / 대한산부인과학회지

Fibrothecoma is mesenchymal tumor deriving from the ovarian stroma composed of theca-like elements and fibrous tissues. Fibroma is rarely associated with Meigs' syndrome which consists of an ovarian fibroma, ascites, and pleural effusion. And also, sclerosing peritonitis associated with thecoma of the ovary is a rare, but intriguing phenomenon characterized by striking peritoneal reactive fibrosis. We have experienced a case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of the bilateral ovaries in a 57-year-old woman. We report a case with brief review of literatures.

Uterine Papillary Serous Carcinoma (UPSC): A Retrospective Study Comparing with Endometrioid Adenocarcinoma / 대한산부인과학회지

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) is uncommon endometrial cancer, but clinically significant because of its poor prognosis. The aim of this study was to identify clinical and pathologic characteristics of patients with uterine papillary serous carcinoma and to evaluate the overall survival compared with endometrioid adenocarcinoma of uterus. METHODS: Twenty one patients with uterine papillary serous carcinoma and 332 patients with endometrioid adenocarcinoma who were surgically staged at the Asan medical Center between 1989 and 2004 were analyzed with review of clinical characteristics; pathologic findings, surgical stages, treatment modalities, prognosis and survival time from medical records and pathologic reports. RESULTS: In 21 patients with uterine papillary serous carcinoma, the median age at the time of diagnosis was 60.9 years (range, 38-81 years), which occurred in 18 postmenopausal women (85.7%) and usually presented with abnormal vaginal bleeding (75%). Obesity, diabetes, hypertension, or a history of hormone replace therapy, known as risk factors of endometrial cancer, were not so frequently associated. In 21 patients with uterine papillary serous carcinoma, there were 10 patients (47.6%) with stage I disease, 2 (9.5%) with stage II, 5 (23.8%) with stage III, and 4 (19.1%) with stage IV. The 3-year survival rate was 97.4% in endometrioid adenocarcinoma and 43.1% in uterine papillary serous carcinoma in all stages. Among 21 patients with uterine papillary serous carcinoma who had surgical staging, 3 patients received only operation and 9 patients received radiation therapy after surgery, 6 patients received chemotherapy and 3 patients received concurrent chemotherapy and radiation therapy. CONCLUSION: Patients with uterine papillary serous carcinoma showed a higher rate of abdominal metastasis and poor prognosis compared to patients of endometrioid adenocarcinoma. Therefore, complete surgical staging like in cases of ovarian cancer is vital in determining disease prognosis and vigorous adjuvant therapies are required.