Guidelines for Cancer Care during the COVID-19 Pandemic in South Korea / Journal of the Korean Cancer Association, 대한암학회지

At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.

Guidelines for Cancer Care during the COVID-19 Pandemic in South Korea / Journal of the Korean Cancer Association, 대한암학회지

At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.

Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer

BACKGROUND: The effects of subclinical hyperthyroidism on fracture risk induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with thyroid cancer still remains controversial. We performed a meta-analysis and systematic review to evaluate the effects of TSH suppression therapy on osteoporotic fracture in patients with thyroid cancer. METHODS: We performed a systematic search to identify studies which included osteoporotic fractures (hip fracture and vertebral fracture) in patients on TSH suppression therapy for thyroid cancer. Main outcome measures were occurrence and risk of osteoporotic fractures including hip and vertebral fractures between patients and controls. RESULTS: A systematic search yielded a total of 8 studies appropriate for review which included osteoporotic fracture outcome in patients on TSH suppression therapy for thyroid cancer. Studies with larger number of subjects showed the higher risk of osteoporotic fracture in group with TSH suppression therapy, although studies with smaller sample size presented a similar risk of fracture with control group. CONCLUSIONS: Although studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the increased risk of osteoporotic fractures in patients with thyroid cancer.

A Case of Male Pseudohermaphroditism due to 17alpha-Hydroxylase Deficiency / 대한불임학회지

Female phenotype of a 46,XY male may originates from male pseudohermaphroditism due to 17alpha-hydroxylase deficiency. Lack of cortisol increases adrenocorticotropic hormone (ACTH) and mineralocorticoid production, leading to low renin hypertention and hypokalemia. A 41-year-old phenotypic female presented primary amenorrhea and hypertension. In the hormonal profile, the levels of serum estradiol, testosterone, rennin, and cortisol were decreased and ACTH and deoxycorticosterone were increased. Laparoscopic bilateral gonadectomy was performed, and corticosteroid, antihypertensive drugs, and estrogen were administered. We report this case with a brief review of the literatures.

A Case of Two Sets of Monozygotic Twins after ICSI and Blastocyst Transfer / 대한산부인과학회지

One of the most important complications in assisted reproductive technology (ART) is multiple pregnancy, which is associated with an increased risk of maternal and perinatal complications. There have been several attempts to achieve the highest pregnancy rates while minimizing multiple pregnancy rates in in vitro fertilization and embryo transfer (IVF-ET). One approach for this purpose is extended embryo culture and transfer of fewer (one or two) blastocysts. However, there are emerging concerns about the increase of the risk for embryo splitting and subsequent monozygotic multiple pregnancy with this approach. Recently, there have been several reports on the possible increased risk of monozygotic twinning after extended embryo culture and blastocyst transfer. We have experienced a case of two sets of monozygotic twins after intracytoplasmic sperm injection (ICSI) and transfer of two blastocysts. We report the first case of pregnancy of monozygotic twins after blastocysts transfer with a brief review of literature in Korea.

Obstetric Outcomes and Congenital Malformations of Children born after Intracytoplasmic Sperm Injection According to the Origin of Sperm / 대한산부인과학회지

OBJECTIVE: To analyze the obstetric outcomes, the incidence of congenital malformations and chromosomal anomalies of neonates born after intracytoplasmic sperm injection (ICSI) according to the origin of sperm. METHODS: A total of 103 neonates born from ICSI between January 1995 and January 2004 was included. They were divided into three groups: ejaculated (n=73), epididymal (n=17) and testicular (n=13) groups. We compared obstetric outcomes such as pregnancy rates, preterm birth rates, abortion rates, multiple pregnancy rates, gestational age at birth, birth-weight, and the incidence of congenital malformations and chromosomal anomalies. RESULTS: There were no differences among the three groups in terms of pregnancy rates, preterm birth rates, abortion rates, multiple pregnancy rates, gestational age at birth and birth-weight. There were no differences in the incidence of low birth-weight babies and very low birth-weight babies. Major malformations were observed in two cases of ejaculatory group (2.7%) and one of testicular group (7.7%). Major malformations included two gastrointestinal malformations and one cleft lip. Minor malformations were observed in three cases of ejaculatory group (4.1%) and one of testicular group (7.7%). Chromosomal anomalies were observed in 6 cases of 105 pregnancies (5.7%), and all of them were from the ejaculatory group. Two cases had autosomal numerical anomalies and 4 cases autosomal structural anomalies. However, sex chromosomal anomalies were not detected in this study. CONCLUSION: The obstetric outcomes, the incidence of congenital malformations and chromosomal anomalies in ICSI babies were not different according to the origin of sperm. These findings should be further investigated in larger long-term studies.

Comparison between Human Follicular Fluid and SpermGrad for Sperm Preparation in Asthenozoospermia / 대한불임학회지

OBJECTIVE: We tested the usefulness of swim-down technique using human follicular fluid (hFF) in sperm preparation. METHODS: Semen samples were obtained from twelve male partners showing asthenozoospermia (sperm motility < 50%) at the time of routine andrologic evaluation in Seoul National University Bundang Hospital. After dividing into two aliquots, each samples were processed either by swim-down using 100% hFF or density gradient using SpermGrad. Sperm quality was assessed by computer-assisted semen analyzer (CASA). RESULTS: Motility, Rapid motility, VCL (curvilinear velocity), ALH (amplitude of lateral head displacement), and hyperactivated sperms were significantly increased, and LIN (mean linearity) was decreased significantly after sperm preparation in both groups. Motility was significantly higher after swim-down using 100% hFF when compared with density gradient using SpermGrad (81.2+/-4.7 vs. 67.6+/-2.3, p=0.02). The other parameters assessed by CASA were not different between the two methods. CONCLUSION: Swim-down method with 100% hFF may be a useful method in preparation of sperm from asthenozoospermia.

A Clinical Significance of Emergency Cerclage for Patients with Advanced Painless Cervical Dilatation / 대한산부인과학회지

OBJECTIVE: To assess the clinical significance of emergency cerclage in the patients with advenced painless cervical dilatation. METHODS: We performed the analysis of the pregnancy outcomes of the 14 patients who underwent emergency cerclage between January 1990 and December 2001 at Seoul National University Hospital. Only singleton pregnancies were included. We compared these results with those of the 56 patients who underwent elective cerclage in the same period. RESULTS: In the patients with emergency cerclage, mean gestational age at cerclage was 20.71 +/- 3.24 weeks and mean gestational age at delivery was 29.84 +/- 7.40 weeks. The mean cerclage-to-delivery interval was 9.14 +/- 7.53 weeks and overall perinatal survival rate was 63.4%. After cerclage, rupture of membrane occurred in 2 cases (14.3%), preterm labor developed in 8 cases (57.1%) and slipping out of cerclage suture developed in 3 cases (21.4%). In comparison with elective cerclage, mean gestational age at delivery, interval between cerclage and delivery, Apgar scores at birth, perinatal death, preterm delivery rate before 28 and 32 weeks' gestation and neonatal birth weight showed worse outcome in emergency cerclage group than elective cerclage group. CONCLUSION: Although emergency cerclage shows worse outcomes than elective cerclage, it seems to be optional treatment modality for patients with painless cervical dilatation considering pregnancy prdongation and neonatal survival.

Comparison of clinical findings associated with the treatment of elderly versus younger patients with epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: To evaluate the differences in the surgical and chemotherapeutic outcomes of elderly versus younger patients with epithelial ovarian cancer. METHODS: We compared clinical characteristics, operative factors and outcomes of chemotherapy of elderly patients 65 years old or over (n=26) with those of younger patients aged 41-49 years (n=47). All subjects underwent their primary surgical therapy and following adjuvant chemotherapy at Seoul National University Hospital, from January 1996 to June 2003. RESULTS: As for tumor characteristics (tumor stage, histology etc.), there were no differences between two groups. Medical comorbidities were more frequent in the elderly group, primarily due to hypertension (50.0% vs. 28.3%; p=0.02). Optimal surgical treatment and adjuvant chemotherapy were performed less frequently in the elderly group (54.2% vs. 78.3; p=0.012). Perioperative and postoperative variables (operation time, intraoperative bleeding, postoperational complications and duration of hospitalization etc.) showed no differences except episode of transfusion in the elderly group. Residual mass, diameter less than 2 cm, showed difference between two groups with marginal significance (30.4% vs 55.6%, p=0.072). Chemotherapeutic dosage reduction was more frequent in elderly group (23.1% vs. 8.5%; p=0.003), but the occurrences of the chemotherapeutic cycle delay and toxicity profiles, were similar in the two groups. Response rate to adjuvant chemotherapy and the number of recurrence were not different between two groups (p=0.119 and p=0.587). CONCLUSION: Elderly women who present the same distribution of stages as their younger counterparts are likely to be treated more conservatively than younger ovarian cancer patients.

Correlation between the Expression of EGFR and the Recurrence of Vulvar Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the expression of epidermal growth factor receptor (EGFR) in vulvar malignancies and to determine if a correlation exists between EGFR levels and various clinical variables. METHODS: Between 1991 and 2003, 28 patients with a diagnosis of the vulva cancer who were treated at Seoul National University Hospital and Korean Cancer Center Hospital, were eligible for the study. EGFR expression was determined using immunohistochemical staining of appropriate tissue samples. RESULTS: EGFR expression was expressed in 7 of 28 (25.0%) vulvar cancer tissues. Although statistically not significant, expression of EGFR was more frequently observed in stage III/IV of vulvar cancer group than stage I/II (60.0% vs 40.0%, p=0.281), in women aged under 60 than older group (57.1% vs. 42.9%, p=1.00), and in premenopause than postmenopause (57.1% vs. 42.9%, p=1.00) Expression of EGFR increased the odds ratio of recurrence (OR=23.750, 95% CI=2.648-212.979). The likelihood of advanced stage and lymph node metastasis is elevated (OR=4.800, 95% CI=0.617-37.351 and OR=4.500, 95% CI=0.542-37.378) without statistical significance. CONCLUSION: EGFR expression had a significant correlation with recurrence of vulvar cancer. In conclusion, this study suggested that EGFR expression may involve in carcinogenesis of vulvar cancer.