Effect of Transdermal Estrogen Therapy on Bone Mineral Density in Postmenopausal Korean Women

OBJECTIVES: To evaluate the effects of transdermal estrogen therapy on bone mineral density (BMD) in postmenopausal Korean women. METHODS: A total of 149 healthy postmenopausal women were retrospectively evaluated: 100 were on hormone therapy (HT) and 49 were the control group. For the HT group, 54 applied estrogen transdermally using either a patch (n = 21) or gel (n = 33), and 46 took estrogen orally (conjugated estrogen 0.625 mg or equivalent). Demographic profiles and changes in BMD over two years were compared according to the route of the estrogen. RESULTS: No differences were found in age, age at menopause, parity, body mass index, and type of menopause among the oral, transdermal and control groups. Compared with controls, HT significantly increased BMD after 2 years in both the lumbar spine and the total hip. The increases in BMD at both lumbar spine and hip were comparable between the oral and transdermal groups. There were also no differences in BMD changes according to progestogen addition in either the oral or transdermal groups. CONCLUSION: Transdermal estrogen therapy increases BMD, comparable to oral estrogen, in postmenopausal Korean women.

Learning curves of total laparoscopic hysterectomies in three gynecologists / 대한산부인과학회지

OBJECTIVE: Total laparoscopic hysterectomy (TLH) is becoming more commonly used as an alternative to traditional abdominal hysterectomy and Analyzing the turning point of a learning curve can be useful in planning training programs. This study was to define the average turning point of a learning curve of TLH by comparing three separate gynecologists in one institute. METHODS: Retrospective analysis of the first 140 consecutive cases of TLH performed by three separate gynecologists A, B, and C. Patients of each gynecologist were divided into 7 equal groups of 20 operations classed chronologically. Patient's age, uterus weight, operation time and pre-post operative hemoglobin difference of the three gynecologists were compared. Operation time and pre-post operative hemoglobin difference were evaluated to build learning curves for each gynecologist. RESULTS: Learning curve built by operation time showed turning point after 80~100 cases in all three gynecologists. Learning curve built by pre-post operative hemoglobin difference did not show a decreasing pattern. There were no statistical differences in patient's age and pre-post operative hemoglobin difference between the three gynecologists. However, mean uterine weight of gynecologist C was significantly lighter than that of gynecologist A and B. Operation time was significantly longer in cases by gynecologist C than in cases by A and B. CONCLUSION: At least 80~100 cases of experience in TLH is needed for a gynecologist to reach the turning point of the learning curve. This result can be used as a guide to the training program of TLH.

Analysis of failed arterial embolization for postpartum hemorrhage / 대한산부인과학회지

OBJECTIVE: To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization. METHODS: Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results. RESULTS: Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different. CONCLUSION: The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.

The National Survey of Breast Cancer Treatment Pattern in Korea (1998): The Use of Breast-Conserving Treatment / 대한방사선종양학회지

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

Adult T cell leukemia/lymphoma with lymphopenia in a Korean

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.

Establishment and Characterization of an Epstein-Barr Virus-negative B-cell Line from a Patient with Dissemination of Peripheral Blood and Bone Marrow by Malignant Lymphoid Cell

A human malignant lymphoid cell line(JeKo-1) was established from a Korean patient with retroperitoneal tumor presenting peripheral blood and bone marrow involvement by malignant lymphoid cells. This cell line was established from peripheral blood, and the cell line had the identical immunophenotypic features as malignant cells from the peripheral blood. The established cell line had features of a mature B-cell phenotype with no evidence for commitment to other lineages. The JeKo-1 grows in suspension with a doubling time of 33 hours. By light and electron microscopic examination, the established cells had a follicular center showing, a small, cleaved, lymphoid appearance, and had a large amount of cytoplasm containing few vacuoles and an irregular cytoplasmic membrane. Immunophenotypic analyses with monoclonal antibodies using flow cytometry showed a monoclonal IgM kappa and CD5- B-cell phenotype. The cells were non-reactive for T-cells and myeloid/monocyte antigens, and no evidence of Epstein-Barr virus nuclear antigen by polymerase chain reaction. DNA analysis showed a hypodiploid stemline with a DNA index of 0.83. The established cells were strongly reactive for bcl-2 and c-myc onco-protein, but lacked expression of multidrug resistance gene protein, p-glycoprotein by Western blot analysis. Karyotypic analysis of JeKo-1 showed 40-41 chromosomes. This cell line should be a valuable tool to study the dissemination of malignant lymphoma into the peripheral blood and bone marrow.

Angiofollicular Lymph Node Hyperplasia(=Castleman's Disease): Report of A Case / 대한치료방사선과학회지

Angiofollicular lymph node hyperplasia (AFLNH) with well marginated lymphoid masses, is a rare benign disease of unknown etiology. The majority of the disease develop intrathoracically. Histologically this disease can be divided into the hyaline-vascular and the plasma cell types with the hyaline-vascular type prevailing. The plasma cell variant has been associated with nephritic syndrome, anemia, growth failure, fever, hyperglobulinemia, peripheral neuropathy, and hypoalbuminemia. Surgical resection is known to be treatment of choice in most cases, and radiotherapy is reserved for advanced, unresectable lesions. We report a complete remission of AFLNH in a case treated by surgical excision followed by irradiation.