The expression of endothelial nitric oxide synthase in the uterus / 대한산부인과학회지

OBJECTIVE: Nitric oxide has a short half-life and is easily oxidized by nitrite, we can indirectly find out its activity by measuring the nitric oxide synthase in cells. The purpose of this study is to confirm the differences in the expression modes of eNOS in uterine endometrium and myometrium between the patients of uterine leiomyoma and the control group. METHODS: We defined the patient group as perimenopausal women who were diagnosed with uterine leiomyoma and underwent total hysterectomy, and the control group as the women who had no lesions in uterus. All of them were classified into proliferative phase and secretory phase by the Noyes standards and compared by immunohistochemical stain for eNOS. RESULTS: There is no significant differences between the patients of uterine leiomyoma and the control group statistically (endometrium P=0.319, myometrium P=0.264). The expression of eNOS in the vascular endothelial cells of the endometrium did not show significant differences statistically by menstrual cycle (proliferative phage P=0.549, secretory phage P=0.240). The expression of eNOS in the myometrium also did not show significant differences by menstrual cycle or by group statistically (proliferative phage P=0.279, secretory phage P=0.224). CONCLUSIONS: In this study, the expression of endothelial nitric oxide synthase was higher in the patients of uterine leiomyoma than in the control group, and during the secretory phase in menstrual period, but there was no statistical significance. We suppose that we can get statistically significant results if we have many cases of subjects.

Bilateral transient osteoporosis of the hip associated with pregnancy: A case report / 대한산부인과학회지

Transient osteoporosis of the hip (TOH) associated with pregnancy is a rare, self- limiting skeletal disorder affecting women, usually in the third trimester, which resolves spontaneously within several months postpartum. Magnetic resonance imaging (MRI) is used primarily for early diagnosis and monitoring the disease progression. Early differentiation from more aggressive conditions such as avascular osteonecrosis, septic coxitis, arthritis, osteomyelitis with long-term sequela is essential to avoid unnecessary treatment. Unilateral involvement of TOH is common. To our knowledge, there has been no case with bilateral involvement of TOH during pregnancy in Korea. We report a rare case with bilateral TOH associated with pregnancy.

Association study of LEP and LEPR gene polymorphisms and the development of type 2 diabetes mellitus in Korean women with a history of gestational diabetes / 대한산부인과학회지

OBJECTIVE: The history of gestational diabetes (GDM) is a high risk for the development of type 2 diabetes mellitus (T2DM). The purpose of this study is to investigate the genetic association of LEP and LEPR gene polymorphisms and the development of T2DM in Korean women of history of GDM. METHODS: Women diagnosed as GDM during pregnancy from January 1992 to December 2002 were recruited. Those women with a T2DM at the time of study were classified as T2DM positive group, and without T2DM, as T2DM negative group. 2 genes (LEP and LEPR genes) and 8 SNPs (LEP-632G>A, +4950G>A, +4998A>C, and LEPR-141013T>C, -186A>G, +5193G>A, +7187A>C, +27265A>G) were selected. The TaqMan assay for genotyping and the statistical analysis for phenotypic and genetic factors between 2 groups were analyzed. RESULTS: A total of 54 women, T2DM positive (n=20) and T2DM negative (n=34) were enrolled. At the time of diagnosis of GDM, HbA1c, 50 g and 100 g oral glucose tolerance test, and insulin level were significantly associated between T2DM positive and negative groups (P<.05). In analysis of genetic risk to T2DM, the significant association related with any SNPs was not shown between T2DM positive and negative groups. CONCLUSION: In Korean women having past history of GDM, there was no relationship between 2 genes and the development to T2DM. To clarify a effect of candidate genes related with development of T2DM, there will need more samples and genes.

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.

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.

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.

Placental Apoptosis from Pregnancies Complicated by Fetal Growth Restriction or Preeclampsia: Expression of Bcl-2, Bax and p53 / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the degree of apoptosis in placentas with pregnancy complicated by fetal growth restriction or preeclampsia as compared with normal term pregnancy placentas and to evaluate the expression of proapoptotic proteins Bax, p53 and antiapoptotic protein Bcl-2 in their placentas. METHODS: Placentas were obtained from 40 normal term pregnancies and from 30 pregnancies complicated by fetal growth restriction or preeclampsia admitted for delivery to the department of Obstetrics and Gynecology of Inha university hospital from January 1 to November 30, 2003. Placental sections were examined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) staining, indicative of apoptosis. The expressions of Bcl-2, Bax, p53 in their placentas were analyzed by immunohistochemical staining. RESULTS: Increased apoptosis was found in the trophoblast layer of villi from pregnancies complicated by fetal growth restriction or preeclampsia (n=30) compared to normal pregnancies (n=40) (0.93 +/- 0.54: 1.5 +/- 1.2) (p=0.014, t-test). There was no statistical significance between the two groups in expressions of Bcl-2, Bax, p53 (p=0.073, p=0.424, p=0.208, chi-square test). CONCLUSION: These results suggest that placental apoptosis may play a role in the pathogenesis of fetal growth restriction or preeclampsia. But placental apoptosis does not seem to be mediated by Bcl-2, Bax, p53 in trophoblasts.

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.

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.

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.

3 Cases of Low-grade Endometrial Stromal Sarcoma / 대한산부인과학회잡지

Endometrial stromal sarcomas (ESS) of the myometrium compose just 0.2% of uterine malignant tumors. In terms of their cellular mitotic activities, they are named as low grade or high grade ESS. As low grade ESS are very rare, we would like to report our 3 cases with immunohistochemical stain method, treatment option as the disease progression and the brief review of literature.

A Case of Peripartum Cardiomyopathy Associated Preeclampsia / 대한산부인과학회잡지

Peripartum cardiomyopathy is an uncommon form of dilated cardiomyopathy that is often fatal to young women. Estimates of the incidence vary from 1 in 1,300 to 1 in 15,000 pregnancies. The diagnostic criteria of peripartum cardiomyopathy are onset of cardiac failure in the latter part of pregnancy or in the puerperium, absence of obvious cause for cardiac failure and absence of demonstrable heart disease before the last trimester of pregnancy. The delayed diagnosis of this disease may be common due to the rarity of this condition. The early diagnosis and medical treatment for this disease is critical because it may affect the patient's long term prognosis. The mortality rate has been reported to be ranged from 25% to 50%. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival. The recurrence of peripartum cardiomyopathy in subsequent pregnancy remains high. The clinical presentation and treatment of patients with peripartum cardiomyopathy are similar to those of patients with congestive heart failure. We experienced a case of this disease in 25 year-old woman who had preeclampsia and preterm labor at 33 weeks of gestation. And report this case with a brief review of the literatures.

Clinical Significance of HPV DNA Chip Test in the Management of Atypical Squamous Cells of Undetermined Significance / 대한산부인과학회잡지

OBJECTIVE: Cervical intraepithelial neoplasia (CIN) and invasive cervix cancer were detected in some cases of atypical squamous cells of undetermined significance (ASCUS) PAP smear. So it is reasonable to evaluate and manage ASCUS PAP smear. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of ASCUS and determine the usefulness of HPV DNA chip test (which is a new diagnostic method for HPV) in management and evaluation of ASCUS patients. METHODS: This study was performed from November 2001 to June 2002 and included 48 cases of ASCUS. They were evaluated by HPV DNA chip test and the pathology was evaluated by punch biopsy, cone biopsy or hysterectomy. The result of type 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 and 69 in HPV DNA chip test were categorized as high risk. RESULTS: The rate of CIN II or above in ASCUS was 18.8% (9/48). The detection rate of high risk HPV DNA in ASCUS was 41.7% (20/48). The detection rate of high risk HPV DNA was 30.6% (11/36) in normal or reactive, 33.3% (1/3) in CIN I, 80% (4/5) in CIN II, 100% (2/2) in CIN III, 100% (2/2) in invasive cervix cancer. Higher the grade of pathology, more the detection rate of high risk HPV DNA chip test. The sensitivity for the prediction of CIN II or above by HPV DNA chip test was 88.9% and specificity was 69.2%, respectively. CONCLUSION: The use of HPV DNA chip test in patients with ASCUS may provide usefulness in detection of CIN II, CIN III and invasive cervix cancer.

Clinical Significance of HPV DNA test for Management of Patients with Diagnosis of Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesions / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the clinical efficacy of high risk HPV DNA test using PCR for the detection of high-grade CIN or invasive cancer from patients with ASCUS or LSIL on Papanicolaou smear. METHODS: Sixty one patients with a Papanicolaou smear report of atypical squamous cells of undetermined significance or a low-grade squamous intraepithelial lesion underwent Cervical colposcopy and directed cervical biopsy and human papillomavirus test by PCR. We compared the detection rate of the high grade CIN and invasive cancer by Papanicolaou smear method only with that of both Papanicolaou smear and HPV PCR method. and we decided to be significant when P value was below 0.05 by SAS (v 6.02) program. RESULTS: The detection rate of high risk HPV DNA was 50.8% (31/61). The detection rate of high risk HPV DNA in high grade CIN and invasive cancer was 84.2% (16/19). Higher the grade of biopsy, more the detection rate of high risk HPV DNA. False negative rate which appeared high grade CIN or invasive cancer by biopsy was 31.2% (19/61) in Papanicolaou smear method only and 4.9% (3/61) in both Papanicolaou smear and HPV DNA method. CONCLUSION: We thought that additional HPV DNA test was useful to dectect behind high grade CIN or invasive cancer when the Papanicolaou smear result was ASCUS or LSIL.

The Report of the Results of HPV Oligonucleotide Microarray Tested on the First Voided Urine of Patients of CIN and Cervix Cancer / 대한산부인과학회잡지

OBJECTIVE: To know whether HPV Oligonucleotide Microarray (HPVDNAChip) can detect the HPV DNA in the urine and, if it can, to compare the results with Pap smear, biopsy, and cervix HPVDNAChip. METHODS: The authors had done Pap smear, cervix HPVDNAChip and colposcopy-guided punch biopsy as well as detailed information to those who visited Dept. of Ob. And Gyn. during 1st of April to 31st of May in 2003 for their uterine cervical problems related to the neoplasia. When they were determined to admit for treatment, urine had been collected to be tested by HPVDNAChip. RESULTS: Among 25 patients enrolled in this study, there were 10 whose urine HPVDNAChip test turned out positive (40%). Among 10 positive results, 9 patients had HPV 16 subtypes. Among 10 urine HPVDNAChip positive patients, there were 5 HSIL, 4 squamous cell cancer (SCC), and 1 ASCUS cell types on the Pap smears. Among 15 urine HPVDNAChip negative patients, there were 7 HSIL, 5 SCC, 1 ASCUS, 1 LSIL, and 1 AGUS. Among 10 urine HPVDNAChip there are 5 CIN3, and 4 invasive SCC, and 1 adenocarcinoma at the biopsy. Among 15 urine HPVDNAChip negative patients, there are 7 CIN3, 6 invasive SCC, 1 adenocarcinoma in situ, and 1 CIN1 patient. Whenever there were a urine HPVDNAChip 16 subtype positive, there were always cervix HPVDNAChip 16 subtype positive, but among the 12 urine HPVDNAChip negative patients, 5 had HPV 16 subtype positive and 4 had another subtypes and 3 had negative on cervix HPVDNAChip tests. CONCLUSION: Using HPVDNAChip, we verified that 40% of patients had the HPV DNA in their urine who had admitted for the treatment of their cervical neoplasm. And HPV 16 subtype was the most common type in the urine. If we can extend this data more widely, we might use it as an auxiliary tool for cervical HPV infection.

A case of endometrial cancer in a young patient with polycystic ovary syndrome / 대한산부인과학회잡지

Endometrial cancer is a rare condition in women under 40 years of age. However, patients with anovulatory polycystic ovary syndrome are at risk of developing endometrial cancer due to unopposed and prolonged effect of estrogen on the endometrium. Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age resulting from insulin resistance and the compensatory hyperinsulinemia. This has adverse effects on multiple organ systems and may result in alteration in serum lipids, anovulation, abnormal uterine bleeding and infertility. In addition, PCOS may place the patients at risk for the development of type 2 diabetes, hypertension, endometrial cancer and cardiovascular disease. We report a case of endometrial cancer in a young patient with PCOS with brief review of the literatures.

Early prediction of birth weight percentile and large for gestational age fetuses using gestation-adjusted projection of estimated fetal weight / 대한산부인과학회잡지

OBJECTIVE: To evaluate the accuracy of predicted birth weight percentile and large for gestational age(LGA) fetuses by the gestation-adjusted projection method using estimated fetal weight. METHODS: From 462 low-risk pregnancies with singleton fetus, fetal biometry including fetal biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC), and femur length(FL) was made from 30 weeks of gestation until term. Estimated fetal weight(EFW) by combinations of fetal biometry were made by Campbell, Hadlock1, Hadlock2, and Shepard formulas respectively. The diagnostic accuracy according to 4 formulas was assessed by correlation between EFW percentile and birth weight percentile, prediction of LGA fetuses, and prediction error(percentile difference between birth weight and EFW). RESULTS: The mean gestational age on ultrasound and on birth, and birth weight were 33.21 +/- 2.08(30-40) weeks, 38.43 +/- 1.72(30-42) weeks, and 3.14 +/- 0.47(0.99-4.38) Kg, respectively. The diagnostic accuracies of gestation-projection method using EFW were similar result to predict birth weight percentile and LGA fetuses according to 4 formulas. Correlation between EFW percentile and birth weight percentile(correlation coefficient, r) were Campbell: 0.644(p <0.001), Hadlock 1: 0.682(p <0.001), Hadlock 2: 0.681(p <0.001), Shepard: 0.638(p <0.001), respectively. Youden's index(sensitivity + specificity - 1) in prediction of LGA fetuses were Campbell: 0.532, Hadlock1: 0.525, Hadlock2: 0.520, Shepard: 0.549, respectively. Prediction error were Campbell: 18.14+/-16.56, Hadlock1: 16.19+/-14.35, Hadlock2: 16.10+/-14.29, Shepard: 19.68+/-17.00, respectively. The prediction error was increased according to increasing of lapse time(p <0.001), gestational weeks on ultrasound, and estimated fetal weight percentile, and decreasing birth weight percentile(p <0.001)(R square=0.411, (p <0.001). But, amniotic fluid index did not affect to prediction error(p=0.199). CONCLUSION: Our study presented relatively accurate prediction for birth weight percentile and LGA fetuses from remote sonographic examination. If LGA fetuses was suspected by antenatal ultrasound, adequate therapy and periodic observation are recommended for good perinatal outcome.

Minimally Invasive Approach for Reoperative Mitral Valve Replacement / 대한흉부외과학회지

Minimally invasive techniques for various cardiac disease are widely accepted in these days. We report a successful case of reoperative mitral valve replacement approached successfully by a small right parasternal incision.