Ultrasound-guided local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate efficacy and safety of local injection of potassium chloride (KCl) and methotrexate (MTX) in the treatment of cornual pregnancy. METHODS: We retrospectively reviewed all cases of cornual pregnancy treated conservatively from 2005 through August 2007. Eight cases were identified and two cases were heterotopic interstitial pregnancy. All cases were managed with local injection of KCl or methotrexate under ultrasound guidance and 2 cases were treated with intra-muscular injection of MTX in combination. After the procedure all cases with cardiac activity was confirmed to be aborted by ultrasound. Also serial follow-up sonographic examination and serum beta-hCG measurement were performed. RESULTS: The mean initial beta-hCG level was 53,331.6 mIU/mL and ranged from 14,332 mIU/mL to 125,721 mIU/mL. Mean gestational age was 48.3 days from 40 to 65 days. All cases were aborted successfully and follow up beta-hCG were declined abruptly. Two cases of heterotopic pregnancy resulted in successful deliveries at full term. CONCLUSION: Cornual resection or hysterectomy should no longer be the first line of treatment for hemodynamically stable patients with cornual pregnancy. They can be successfully treated through local injection of MTX or KCl by ultrasound guidance.

Expression of Wnt 1 and beta-catenin in epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: We were trying to identify the expression of Wnt 1 and beta-catenin in normal ovarian epithelium and epithelial ovarian tumor. METHODS: We used archival formalin-fixed and paraffin-embedded tissues from Comprehensive Gynecologic Cancer Center and the Department of Pathology at Bundang CHA Hospital from 2000 to 2005. Immunohistochemical staining for Wnt 1 and beta-catenin was performed on the ovarian epithelial tissues. Statistical analyses were performed with SPSS 10.1 for Windows and significance was defined as P<0.05. RESULTS: Of 114 cases, the cases were composed of 54 carcinomas, 40 borderline tumors, 12 benign tumors and 8 normal control ovarian tissues. Abnormal nucleocytoplasmic expression of beta-catenin was found in 4 endometrioid carcinomas. The nuclear expression of beta-catenin was found especially in the components of the endometrioid carcinoma (28.6%, P<0.05). Wnt 1 was overexpressed in all 9 clear cell carcinomas, but not frequent in the other types of malignant tumors (P<0.05). We found a statistically significant correlation between beta-catenin nuclear localization and endometrioid carcinomas. And we found a significant correlation between Wnt 1 expression and clear cell carcinomas. CONCLUSION: It does not seem that Wnt 1 over expression directly provoke the nuclear localization of beta-catenin. But, deregulation of beta-catenin and Wnt 1 may play a role in the pathogenesis of ovarian epithelial carcinogenesis of endometriod carcinoma and clear cell carcinoma. Evaluating this avenue of regulation of beta-catenin and Wnt protein in ovarian epithelial carcinoma may provide a new direction for early diagnosis and treatment in ovarian epithelial carcinoma and provide opportunities for making a certain biomarkers.

Expression analysis of mRNA and proteins related to angiogenesis following management with cytotoxic agents in gynecologic cancer cell lines / 대한산부인과학회지

OBJECTIVE: Angiogenesis is central role to both the proliferation and metastasis of malignant tumor. The intense interest in angiogenesis has also lead to a re-examination of the activity of established cytotoxic agents which are known to be an antiangiogenic effect anecdotally. In this study, anti-angiogenic effect of cisplatin, paclitaxel and thalidomide was evaluated in human ovarian cancer cell lines and cervical cancer cell line. METHODS: Human ovarian cancer cell line A2780, cisplatin resistant human ovarian cancer cell line A2780-CDDP, human breast cancer cell line MCF-7, and squamous cell uterine cervical carcinoma cell line SiHa were used to evaluate the level of mRNA and protein expression of VEGF, bFGF and TSP-1, 2 before and after the treatment with cisplatin, paclitaxel, and thalidomide using RT-PCR, protein extraction, and Western blot. The results were analyzed with Wilcoxon signed rank test in the SAS ver 8.1. RESULTS: Targeted mRNAs were synthesized as 212 bp VEGF, 238 bp bFGF, and 492 bp band sized except mRNA of TSP-2 via RT-PCR. The protein of VEGF and bFGF were appeared as 21KDa and 17 KDa size, however, the protein of TSP-1 was not appeared through western blot. No effect of cisplatin on protein expression was measured in these cell lines, but paclitaxel influenced the expression of bFGF in MCF-7 cell line and the expression of TSP-1 in MCF-7 and SiHa cell lines. TSP-1 expression was influenced by thalidomide in A2780 cell line. The protein expression of VEGF and bFGF were not influenced following treatment with cisplatin, paclitaxel, and thalidomide. CONCLUSION: These results were suggested that bFGF and TSP-1 will be used as a target gene for the assay of antiangiogenic effect of paclitaxel in breast and uterine cervical cancer tissue and TSP-1 will be used as that of thalidomide in ovarian cancer. Furthermore, thalidomide will be tried as an adjunctive agent for the improvement of the survival in the case of the patient with ovarian cancer.

The effectiveness of Lysophosphatic acid (LPA) as a biological marker in gynecologic cancer patients / 대한산부인과학회잡지

OBJECTIVE: LPAs are suggested as useful biological markers in early detection of ovarian carcinoma and other gynecological malignancies except breast and hematologic malignancy. We assessed the possible diagnostic role of serum LPA level in cervical, ovarian and the uterine corpus in Korean women. METHODS: The patients were enrolled in Hanyang University Hospital, Department of OB/GYN from Jan. 1999 to Jun. 2001. There were 19 ovarian carcinomas including 2 metastatic carcinomas, and 1 primary peritoneal carcinoma, 10 cervical carcinomas, 6 uterine carcinomas, 15 benign tumor as the study group and 5 healthy nulliparous women as the control group. Plasma was obtained following the centrifuge of whole blood, LPA was extracted from the plasma and the level was assessed by tandem mass spectrometry in multiple reaction mode. The quantity was measured by ratio of level of LPA and standard material, C14:0 LPA, in chromatogram compared with standard. The level of LPA were compared among control group, benign disease and gynecological malignancies, and also with conventional tumor markers. The statistical significance was analyzed by unpaired student-T test and McNemar test. RESULTS: The mean level of LPA and standard deviation were 7.1698 nmol/mL, 1.70 in malignancies, 4.5357 nmol/mL, 1.10 in benign disease and 5.2812 nmol/mL, 0.88 in healthy control. The level of LPA was significantly higher than in benign and control groups (p0.05). But, in cervical cancer, LPA level is more sensitive than CEA (p=0.039). CONCLUSION: The levels of LPA in cervical cancer, uterine cancer, ovarian carcinoma were significantly higher than in benign disease. Thus LPA is considered as an useful tumor marker in diagnosis and follow-up after treatment, especially in recurrent cervical carcinoma and uterine carcinoma which have no sensitive tumor markers. But further study with large number of casesfor a long period is required for clinical application in the future.

Effects of progesterone/progestin on the apoptosis of the human umbilical vein endothelial cell / 대한산부인과학회잡지

OBJECTIVE: The addition of progesterone/progestin is mandatory in women with intact uterus for postmenopausal hormone replacement therapy. However, debate is continuing on whether there is an impact of progesterone/progestin on the hormone replacement therapy for cardiac protection. The aim of this study was to investigate the effect of progesterone/progestin and combination with estrogen on the apoptosis of vascular endothelial cells, which has been demonstrated to be an initial step in the development of atherosclerosis. MATERIAL AND METHODS: Human Umbilical Vein Endothelial Cells (HUVEC) were cultured. HUVEC apoptosis was induced by Tumor Necrosis Factor-alpha (TNF-alpha) (50 ng/ml). 10-7M of estradiol (E2), progesterone (P4), medroxyprogesterone acetate (MPA) and norethindrone acetate (NETA) were added in to the culture media. The percentage of apoptotic HUVEC were measured by 3-[4,5-Dimethylthiazol-2-yl]-2,5- diphenyltetrazolium bromide (MTT) assay and Fluorescence Activated Cell Sorting (FACS) analysis. RESULTS: MTT assay demonstrated a significant decrease in percent of survival cells after 24 hours of TNF-alpha exposure and a reversal of the effect of TNF-alpha with E2 treatment. P4, MPA and NETA treatment also reversed the effect of TNF-alpha. The protective effect of E2 and P4 were not different. Compared to the E2 treatment, the percent of survival cell were decreased when P4, MPA and NETA were added to E2 treatment, respectively. Similarly, FACS analysis revealed 44.0+/-2.6% apoptosis after 24 hours of TNF-alpha exposure. Treatment with E2 resulted a significant decrease (28.4+/-2.9%, P<0.05) in apoptosis. P4 (33.6%+/-2.6%, P<0.05), MPA (35.7+/-1.3%, P<0.05), NETA (34.0+/-3.3%, P<0.05) treatment also showed a reduction of cell death. The percent of apoptotic cells between E2 and MPA treatment was significantly different. The addition of P4 (36.0+/-2.5%), MPA (36.3+/-1.9%) and NETA (37.0+/-2.0%) to E2 treatment significantly increased the percent of apoptotic cells compared to those of E2 treatment. CONCLUSION: These results suggested that not only estradiol, but also progesterone, MPA and NETA inhibited HUVEC apoptosis. But the effect of estrogen on the inhibition of HUVEC apoptosis was attenuated in combination treatment of estrogen and progesterone/progestin.

Vaginal birth after cesarean section: A 10-years study / 대한산부인과학회잡지

OBJECTIVE: Recently, enormous amount of the studies about trial of labor after cesarean section has been reported to decrease the rate of cesarean section. This study focused on analyzing multiple variables and results to acknowledge the safety and complications of VBAC (vaginal birth after cesarean section). METHODS AND MATERIALS: This study was performed based on 97 pregnant women who were tried vaginal delivery after cesarean section at Hanyang University Hospital from January 1990 to December 1999. The age of mother, gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical dilatation, cervical effacement, Bishop score, the number of previous vaginal delivery, complications of mother, and complications of fetus were analyzed between successful group (82 patients) and failure group (15 patients) with trial of labor. Student T-test and Chi-square test were used for statistical analysis. RESULTS: In the 97 cases with trial of labor after cesarean, the success rate was 84.5% and failure rate was 15.5%. The estimated fetal body weight by ultrasonography, cervical dilatation and effacement, Bishop score, Apgar score had notable differences between successful group and failure group, while the other factors had not. There was no maternal death or uterine rupture in the cases of trial of labor. CONCLUSION: Trial of labor after cesarean section is relatively safe method of delivery if it is performed under strict indication. It could be suggested that VBAC has relatively little complication in both mother and fetus. The studies with large populations and performed by multi-centers will be needed for the evaluating safety of VBAC and developing safe protocols to decrease the risk of complications.

Bone mineral density changes after 4 years of hormone replacement therapy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the various effects of hormone replacement therapy (HRT) on bone mineral density (BMD) for 4 years in postmenopausal women and to compare the characteristics of non-responders to HRT. METHODS: A total of 100 postmenopausal women have been treated with HRT or estrogen replacement therapy for 4 years. Spinal BMD was measured by dual energy X-ray absorptiometry. RESULTS: The mean age and menopausal age of the study subjects was 53.3+/-3.6 and 4.7+/-4.0 years. According to the baseline BMD, 32 and 9 women were osteopenic and osteoporotic. Compared with the baseline value, the lumbar BMD increased significantly after one and two years of HRT, but after three years the rate of increment has slowed. However, the change of BMD has significantly increased again after four years of HRT (3.98%, 5.36%, 5.41%, 6.16%, in each year, respectively). Women with baseline osteopenia and osteoporotis gained significantly more BMD after 1 year of HRT than women with baseline normal BMD (p=0.02). There were no significant differences of BMD changes among the 3 treatment regimens (continuous combined, cyclic combined, and estrogen only). After 1 year of HRT, 14 non-responders were indentified who had reduced BMD (-1.7+/-1.6%) compared with baseline BMD whereas 86 responders had increased BMD (4.9+/-4.1%). In the non-responder, BMD increased in two year of HRT but decreased in the three and four year of HRT while BMD increased in the two, three and four year of HRT in responders. After 4 years of HRT, 17 nonresponders (-3.0%+/-1.8%) and 83 responders (8.2+/-7.1%) were indentified. There was no significant difference in age, year since menopause, body mass index and baseline BMD between non-responders and responders. However, non-responders loose their BMD after 1 and 4 year of HRT. CONCLUSION: After HRT, the BMD increased not only first and second year but also fourth year of treatment. The BMD changes did not different according to the treatment regimens. The lower the women's baseline BMD, the greater the BMD increase after HRT. After four years of HRT, 17% of women lose their BMD compared to baseline BMD. The BMD changes in the first year of HRT may be an important predictive factor for the long-term BMD response to HRT in postmenopausal women.

Clinical significance of ascitic p53 autoantibodies as a prognostic factor in patients with epithelial ovarian carcinoma / 대한산부인과학회잡지

OBJECTIVES: A study was to assess the prognostic significance of ascitic anti-p53 autoantibodies in patients with advanced ovarian carcinoma. METHODS: Retrospective study was peformed in 43 ovarian carcinoma patients who presented with a significant amount of ascites at the Department of Obstetrics and Gynecology in Hanyang University Hospital between 1991 to 2000. p53 autoantibodies were determined by highly specific enzyme-linked immunosorbant assay (p53-Autoantibody ELISAplus, CAT QI A53, A CN Bioscience Company, Boston). The 'positive' and 'negative' group were categorized on the basis of the presence of anti-p53 autoantibodies. The clinicopathologic characteristics, disease free survival and overall survival rate in each groups were compared. Statistical analysis was performed by X2 and independent sample t-test. RESULT: Ascitic anti-p53 autoantibodies were found in 16% (7/43) of the study patients. The positive rates were revealed as follows : serous 15% (2/13), mucinous 11% (2/17), undifferentiated, 42% (3/7) in histologic type ; stage I/II5% (1/21), III/IV 27% (6/16); grade I/II12% (3/26), III 24% (4/17). There was no correlation between clinicopathologic characteristics and the presence of ascitic anti-p53 autoantibodies except the stage of disease. The overall survival rate revealed no significant statistical meaning (20.0 vs 35.7 months, p=0.492). In contrast, disease free survival rate was decreased in positive group. (10.0 vs 24.7 months, p=0.032). A significance association was observed between presence of ascitic anti-p53 autoantibody and response to chemotherapy. Ascitic anti-p53 autoantibodies were detected in only 3 (16%) of 18 patients who achieved pathological partial and complete response, but it was detected in 3 (75%) of 4 patients who did not respond to chemotherapy (p=0.046). CONCLUSION: The presence of p53 autoantibodies in ascites is tend to be associated with advanced stage and poorly differentiated group. A significant correlation was observed between presence of ascitic p53 autoantibodies and decrease in disease free survival rate suggesting that it is related to poor prognosis. Moreover, presence of ascitic p53 autoantibodies was also related to chemoresistance. But since this study is retrospective and based on very limited case, further study is warranted to be performed prospectively and based on larger number of study group.

The study on the regression time and pattern of the serum beta-hCG in gestational trophoblastic disease / 대한산부인과학회잡지

OBJECTIVES: It is now conventional practice to use human chorionic gonadotropin (hCG) as the marker of tumor activity in gestational trophoblastic disease (GTD). The interpretation of serial serum beta-hCG regression patterns is important in monitoring the course of the disease. The purpose of this study was to establish a regression time and pattern of the serum beta-hCG in which GTD is divided into hydatidiform mole and malignant trophoblastic disease. MATERIALS & METHODS: During the period from January 1990 through December 2000, 46 patients with GTD were histopathologically diagnosed and treated at the department of Obstetrics and Gynecology in Hanyang University Hospital. For the purpose of analysis and comparison, patients were divided into 19 cases of hydatidiform mole and 27 cases of malignant trophoblastic disease which was subdivided into nonmetastatic (17) and metastatic (10). Patients were followed clinically and by weekly estimations of quantitative serum beta-hCG until negative (<3 mIU/ml). After three consecutive negative beta-hCG, serum beta-hCG were drawn monthly in all patients for one year. The level of serum beta-hCG was detected by two-site sandwich immunoassay (Chiron Diagnostics Automated Chemiluminescence System 180). The obtained data were analyzed using t test and ANOVA test by SPSS. RESULTS: The incidence of the GTD compared with delivery was one per 182.7 deliveries. The mean value of serum beta-hCG regression time in hydatidiform mole was 12.8+/-1.1 (SEM) weeks (7.0-26.0 weeks) and 17.9+/-1.4 (SEM) weeks (8.0-34.0 weeks) in malignant trophoblastic disease. The regression time was significantly shorter in hydatidiform mole than that of malignant trophoblastic disease (P<0.01). The differences of mean value of serum beta-hCG regression time between the groups with nonmetastatic (18.0 weeks) and metastatic (17.8 weeks) were not statistically significant(P =0.946). The mean values of serum beta-hCG in both hydatidiform mole and malignant trophoblastic disease declined following a log-normal distribution. CONCLUSIONS: The regression pattern of serum beta-hCG in present study was similar to that of which in Western and also similar to that of which in Korea in 1980s. The present study supports the continued use of individual patients serum beta-hCG regression curve to make treatment decision and to recognize malignant trophoblastic disease promptly.

Splenosis with Cyclic Abdominal Pain Misdiagnosed as Ovarian Dermoid Cyst

Splenosis is defined as the autotransplantation of splenic tissue after a traumatic splenic injury or a splenectomy. It has often been mistaken as an endometriosis, an intraperitoneal carcinoma, a hemangioma and an accessory spleen. It is clinically significant in that it requires no treatment if it is asymptomatic. Here we report a case of 34 year-old woman who had a pelvic splenosis with cyclic abdominal pain for several years, which was initially misdiagnosed as ovarian dermoid cyst. At the time of exploration, a splenosis was observed in the pelvic cavity. After surgery, a multiple splenosis in the abdominal cavity was found through a Tc-99m heat denatured red blood cell scan. The removal of the splenosis in the pelvic cavity resulted in an improvement in her symptoms.

The Sex Ratio of Offspring in Pregnancies Complicated with Hyperemesis Gravidarum / 대한주산의학회잡지

OBJECTIVES: There are a few studies reporting difference in sex ratio at birth in pregnancies complicated with hyperemesis gravidarum but it has not been reported in domestic journals yet. The purpose of this study is to evaluate difference of sex ratio in hyperemesis gravidarum patients compared to normal pregnant women. MATERIALS AND METHODS: We identified 111 women who were diagnosed as hyperemesis gravidarum and had delivered babies in Hanyang University Hospital between Jan. 1995 to Dec. 2000. The control group was 1995 women who had no obstetric problems including hyperemesis gravidarum during the pregnancy and had delivered baby at term. We compared the sex ratio of infant and the characteristics of these two groups. The study group was divided into two subgroups depending on the severity of disease, mild group and severe group, and difference of sex ratio in these group were also compared. We analyzed the data using student T-test and chi-square test and p-value < 0.05 was considered as statistically significant. RESULTS: Compared to sex ratio(female:male) of control group(44.8:55.2), hyperemesis gravidarum showed the sex ratio of 58.6:41.4(p=0.005). There was no further difference of sex ratio between two subgroups of hyperemesis gravidarum according to severity of disease. CONCLUSION: In pregnancies complicated with hyperemesis gravidarum the sex ratio of female was significantly high. The studies based on more variables and larger population would produce more accurate results.

Expression analysis of genes related to multidrug resistance (MDR) in ovarian cancer cell line A2780 and cisplatinum resistant cell line A2780cp / 대한산부인과학회잡지

OBJECTIVE: Expressions of P-glycoprotein, the multidrug resistance-associated protein (MRP) and the lung resistance protein (LRP) with the MDR phenotype widely divergent in human cancer cell lines. This study focused on the altered gene expression related drug transport. METHODS: To examine correlations between MDR-associated genes and PKC isozyme with cisplatin resistance on the level of the mRNA expression, we analyzed MDR-associated gene (LRP, MDR1/P-gp and MRP) expression and PKC isozyme, topoisomerase II alpha and beta in cisplatin-sensitive ovarian cancer cell line A2780 and cisplatin - resistant cell line A2780cp using cDNA-PCR approach. RESULTS: LRP mRNA levels were significantly increased in A2780cp compared to the drug sensitive variant. In contrast, MRP mRNA levels were not significantly correlated with drug sensitivity. A modest increase in PKC(eta) and MDR1/P-gp mRNA expression activity was also observed in ovarian cancer A2780cp cell lines that were resistant to CDDP. The level of topoisomerase II alpha and beta were not affected. CONCLUSION: These results showed that MDR1/P-gp expression may be an important determinant of the MDR phenotype in cell lines intrinsically resistant to cancer chemotherapeutic agents and a multifactorial emergence of MDR phenotype of tumor with a possible involvement of the PKC isozymes may be associated with CDDP resistant ovarian cancer cell line.

The Effect of low-dose Aspirin and Clomiphene Citrate on the Expression of Neural Cell Adhesion Molecules (NCAM) in the Human Endometrium / 대한산부인과학회잡지

OBJECTIVE: The treatment with low-dose aspirin in the patients with unexplained infertility has been reported to improve the pregnancy rate and implantation rate via increasing the blood flow in the endometrium. But there are little known about the relationships between low-dose aspirin and cell adhesion molecules, NCAM. The aim of this study was to evaluate the effect of low-dose aspirin and clomiphene citrate treatment on the expression of NCAM in the endometrium. METHODS: The patients with unexplained infertility (N=37) were grouped into 3 groups: clomiphene citrate and low-dose aspirin treated group (N=8), clomiphene citrate treated group (N=10), and natural cycle group (N=10, no treatment). As control group, the proliferative and menopausal endometrium was used. Each endometium was obtained by endometrial biopsy performed in late luteal phase and immunohistochemical staining with NCAM was performed. RESULTS: In the stromal cells, the staining intensity of NCAM expression and the number of vessels were significantly increased in the endomterium treated with clomiphene citrate and low-dose aspirin compared with other groups (p<0.05). And the expression of NCAM in the prolifertive and menopausal endometrium showed very weak staining. CONCLUSION: The expression of NCAM in the stromal cells and the number of vessels were increased in the endometrium of unexplained infertility patients treated with clomiphene citrate and low-dose aspirin. These findings may suggest low-dose aspirin has an important role during the secretory phase of endometrium to improve the implantation via increasing the expression of cell adhesion molecules, especially NCAM and increasing the number of vessels.

The clinical efficacy of single - dose methotrexate in unruptured tubal pregnancy / 대한산부인과학회잡지

OBJECTIVES: The early detection of ectopic tubal pregnancy in unruptured state is increased as the transvaginal sonography and sensitive serum hCG test are available. For this unruptured tubal pregnancy, the medical treatment using methotrexate via various routes and dosage is being tried. Our study was to evaluate the efficacy of single systemic injection of methotrexate in the treatment of unruptured tubal pregnancies. Material and METHODS: From the January 1997 to July 1999, of 152 ectopic pregnancy patients, 22 patients who were diagnosed as unruptured tubal pregnancies were treated with single-dose systemic methotrexate injection (50 mg/m2/IM). Exclusion criteria were unstable vital signs with hemoperitoneum, adnexal mass > 5-6 cm. Serum hCG titers were checked before injection and 4, 7 day after injection. If serum hCG titer declined more than 15% on 7 day after injection compared with titer on 4 day, the weekly hCG titer was followed until it was <10 mIU/ml .If the hCG titer did not decline more than 15 %, a second dose was given. If hCG titer was not decreased or vital signs became unstable after 1-2 injections, the treatment was considered failure and surgery was done. RESULTS: 18 cases (82%) of 22 were successfully treated with single-dose methotrexate. The mean size of ectopic mass and initial serum hCG titers were 2.7+/-1.3 cm (range, 1.5-5.4 cm) and 3,298+/-1,007 mIU/ml (range, 132-12,239), respectively. Of 22, 6 cases (28%) needed second dose of methotrexate. The mean time to resolution of serum beta-hCG titer was 27.5+/-13.6 days (range, 8-53 days). Elevation of liver enzyme did not occurred in all cases during treatment. Initial hCG titer was more important prognostic factor than ectopic mass size for successful medical treatment. CONCLUSION: Single-dose methotrexate appears to be an effective medical treatment for the unruptured tubal pregnancy. However, patients selection using strict criteria is needed to increase its success rate.

A Case of placenta increta which was found about 50days after induced abortion at 1st Trimester / 대한산부인과학회잡지

During 1st and 2nd trimester, placenta accreta is rarely found and is not easy to diagnosis during these trimester. From time to time placenta accreta is found after induced abortion or spontaneous abortion. We had experienced a case of placenta increta which was found about 50 days after D&C due to missed abortion at local clinic. So we presented it with a brief case history and brief review of the concerned literatures.

A Case of Patau Syndrome Diagnosed in Early Pregnancy / 대한산부인과학회잡지

Patau syndrome, or Trisomy 13 is one of the most common autosomal aberration associtated with multiple congenital abnormalities. We report a case with trisomy 13 mosacism which was found during an amniocentesis performed due to the age of the mother and abnormal nuchal translucency. The clinical features of fetus included cleft lip and palate, low set ears, polydactily, small ""micro"" penis, and Rocker-bottom feet. After termination of the pregnancy, the fetus was sent for an autopsy. The autopsy report was compatible with the gross findings and pulmonary hypoplasia, microophthalmia, hypoplasia of left ventricle of heart were found.

Primary peritoneal pregnancy implanted on the uterosacral ligament: a case report

Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus.

The Clinical Study of the Torsion of the Ovarian Tumor in Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the clinicopathologic characteristics of the torsion of the ovarian tumor in postmenopausal women. METHODS: We reviewed the medical records of 20 postmenopausal patients with a postoperative diagnosis of torsion of the ovarian tumor in Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1989 to December 1998. RESULTS: The postmenopausal patients with torsion of the ovarian tumor constitute 20/94 (21.3%) of all adnexal torsion patients encountered during this period. The mean (+/-SD) age of the 20 patients was 63.5+/-9.0 years, with a range of 52-90 years. The mean time since menopause was 16.5+/-10.3 years, with a range of 1-39 years. The mean parity was 5.4+/-2.0 (range of 3-10). Lower abdominal pain (65%) was the most frequently presenting symptom, palpable mass(20%) or diagnosed mass(15%) being the second. But, in 20% of cases there was no lower abdominal pain. The torsion occurred at the right side in 11cases (55%) and at the left side in 9 cases. The most frequent degree of torsion was those cases that was rotated twice (720 degrees). The neoplasms undergoing torsion ranged in diameter between 5cm and 30cm and the most prevalent size was 6 to 10 cm (8 cases). Most of the patients (17cases) were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. The tumors that produce torsion varied histologically and the most common type was cystic teratoma (in 5 cases), simple cyst(in 3 cases), serous cystadenoma(in 2 cases), mucinous cystadenoma(in 2 cases). CONCLUSIONS: In our study, ovarian tumor torsion occurring in postmenopausal patients constituted approximately 20% of all torsion patients, therefore adnexal torsion should be considered when a postmenopausal woman presents with lower abdominal pain. When torsion is diagnosed, total abdominal hysterectomy and bilateral salpingo-oophorectomy is the usual treatment for postmenopausal patients. Histologically, in more than 90% of cases, the tumors that produce torsion were benign. If cancer is evident, more extensive surgery is required.

A Case of Neonatal Death due to Group B beta-Hemolytic Streptococcal Sepsis / 대한산부인과학회잡지

Since 1970, the group B streptococcus(GBS) has been a significant cause of neonatal sepsis in the West. Two distinct forms of disease occur in neonates. Early-onset disease which occurs within 7 days after birth is characterized by respiratory distress, apnea, shock, pneumonia, and occasionally meningitis. Late onset disease usually occurs at 3-4 weeks of age(ranging from 7 days to 3 months) and presents occult bacteremia or meningitis. The GBS is thought to be a rare causative agent for neonatal sepsis in Korea. Lately, we experience a case of early-onset GBS sepsis who died at 3rd day of life. We present this case with brief review of literatures.

Expression Pattern of Insulin - like Growth Factor - II in Human Fallopian Tubal Epithelium / 대한산부인과학회잡지

No abstract available.