Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

The clinical efficacy and cost-effectiveness of Lamellar body count in fetal lung maturation test / 대한산부인과학회잡지

OBJECTIVE: To evaluate the availability and efficacy of the Lamellar body count as a predictor of fetal lung maturity METHODS: Amniocentesis was performed for evaluation of fetal lung maturity status within 72 hours of delivery in 32 patients. A Lamellar body count in clean amniotic fluid (AF) was analyzed right after amniocentesis. In case of contaminated AF with meconium or blood, samples was centrifuged for 3 minutes and divided into three. The average of three samples was analyzed successively from Coulter counter. RESULTS: The incidence of RDS showed significant relation with gestational age, 1-minute and 5-minute Apgar Score. Using a value greater than 30,000/ l to indicate pulmonary maturity, the Lamellar body count predicted all lung-maturated cases with no false-negative results (100% negative predictive value). All 4 cases of RDS demonstrated Lamellar body count less than 30,000/microl. By using a lower cutoff of 10,000/microl to predict pulmonary immaturity. Positive predictive value was 100% in RDS patients. CONCLUSION: In high risk pregnancy, fetal lung maturity test from amniotic fluid lamellar body count is a rapid, simple and reliable method in making a decision of delivery-time. And also it has universal availability with cost-effectiveness when we consider the reality of korean medical situation

A Case of Primary Choriocarcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary choriocarcinoma of the fallopian tube has been known for 4% of choriocarcinoma also 1.7% of gestational trophoblastic disease. Its symptom and sign in presentation are similar to the ectopic pregnancy or adnexal mass, thus it is confirmed through histopathological descriptions after explolaparotomy or laparoscopy. Mostly it is common in younger women who are reproductive, we have done conservative surgery followed by chemotherapy. After that, the prognosis was good. We have experienced a case of primary choriocarcinoma of the fallopian tube and reported with a brief review.

A case of Necrotizing Fascitis after Cesarean Section / 대한산부인과학회잡지

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.

A case of Neuroblastoma Diagnosed by Prenatal Ultrasonography / 대한산부인과학회잡지

We report a case that a neuroblastoma in a fetus was recognized before birth and its growth could be observed. The diagnosis was made by ultrasonography. The suprarenal mass initially showed pure cystic features on ultrasound. Surgical exploration revealed an adrenal cystic tumor and histology showed a neuroblastoma in situ. Forty-five infants with prenatally detected neuroblastoma were found in the English literature; about one-half of them were cystic neuroblastomas and most had a favorable outcome.

Growth Regulation of Ovarian Cancer Cells through the Inactivation of AP-1 by Retinoid Derivatives / 대한암학회지

PURPOSE: The growth regulatory effect of retinoid derivatives could be mediated by the transcriptional inactivation of AP-1 oncogenic transcription factor. By using ovarian cancer cell lines we were to investigate the cross-regulation mechanism between retinoids and AP-1. MATERIALS AND METHODS: Cell proliferation assays were performed in 4 ovarian cancer cells (A2774, PA-1, OVCAR-3, SKOV-3) by increasing the concentrations of all-trans retinoic acid (ATRA), 9-cis retinoic acid (9RA), 13-cis RA (13RA), 4-hydroxyphenyl retinamide (4-HPR). Transient transfection and CAT ELISA were done to determine the selective activity of each retinoid on the RAR (alpha, beta, gamma), RXR (alpha, beta, gamma). and the negative activity on AP-1 (c-Jun). RESULTS: Antiproliferative effect of 4-HPR (IC50; 0.7~2.7 micrometer) was more potent than those of other retinoid derivatives (IC50; 2.7~9.0 micrometer). To assess the anticancer mechanism, we examined the effect of 4-HPR on the transriptional activity of retinoic acid receptors (RAR/RXR) and of c-jun. Contrary to other retinoid derivatives that are active for RAR and RXR with some different levels, 4-HPR showed weak activity only for RARgamma. However, 4-HPR exerted the strongest suppression on AP-1 (c-Jun) activity. CONCLUSION: Based on our results showing much 4-HPR's potent antiproliferative activity coupled with the most effectively inhibiting activity on AP-1 and minimum activity on RA receptor (selective for RARgamma) than other retinoid derivatives, we suggest that 4-HPR may be a novel, and very effective anticancer drugs for ovarian cancer.

A Case of Heterotopic Pregnancy Following IVF-ET / 대한산부인과학회잡지

The simultaneous existence of intrauterine and extrauterine pregnancies is known as a heterotopic pregnancy. Spontaneous heterotopic pregnancy is a rare event although its incidence has increased since the recent development of treatment of infertile women with ovulation induction or in-vitro fertilization and embryo transfer(IVF-ET).The theoretical rate of this condition was estimated to be approximately 1 in 30,000 pregnancies. The early diagnosis of heterotopic pregnancy is very difficult . So there is a high maternal morbidity and fetal loss. We reported a IVP - ET patient resulting in the successful delivery of live infant at 35weeks of gestational age from intrauterine pregnancy following surgical removal of ruptured concurrent extrauterine pregnancy.

Mutation of DNA Mismatch Repair Genes and its Relation to Taxol and Topotecan Chemosensitivity in the Clones from the Cisplatin-Resistant Ovarian Cancer Cell Lines / 대한산부인과학회잡지

OBJECTIVE: Ovarian cancer represents a relatively chemosensitive solid tumor, with responsiveness to a range of agents. Cisplatin is the mainstay of drug treatment and is one of the most active single agent. However, the overall outcome for patients remains unsatisfactory and the emergence of drug resistance is a major factor in treatment failure. Loss of DNA mismatch repair is a common finding in many types of sporadic cancer as well as in patients with hereditary nonpolyposis colon cancer. Cells that lack DNA mismatch repair are resistant to commonly used chemotherapeutic agents. Selection of cells for resistance to cisplatin, a well-recognized mutagen, could result in mutation in genes involved in DNA mismatch repair. METHODS: This study evaluated the mutation of hMLH1 and hMSH2, and its relation to the Taxol and Topotecan chemosensitivity in the clones from the ovarian cancer cell line 2008 and cisplatin-resistant cell line 2008/ C13*5.25. RESULTS: 1. Cells from 2008 and 2008/C13*5.25 expressed both hMLH1 and hMSH2 when analysed with immunoblotting. 2. Twenty two out of 100 single-cell clones from 2008 and 27 of clones from 2008/C13*5.25 expressed no hMLH1. hMSH2 was expressed in all clones. 3. There was no difference of Taxol chemosensitivity between 2008 and 2008/C13*5.25 cell lines. In the 2008/C13*5.25 cell line, the hMLH1-deficient clones were more sensitive to Taxol than the hMLH1-proficient clones(P=0.049), but in 2008 cell lines hMLH1-proficient clones were more sesitive to Taxol(P=0.003). 4. There was no difference in Topotecan chemosensitivity between 2008 and 2008/C13*5.25 cell lines. In the 2008/C13*5.25 cell line, the hMLH1- deficient clones were not more sensitive to Topotecan than the hMLH1-proficient clones. In the 2008 cell lines hMLH1-deficient clones were more sesitive to Topotecan(P=0.001). Overall, hMLH1-deficient clones from both 2008 and 2008/C13*5.25 cell lines were significantly more sensitive to Topotecan(P=0.001). 5. Microsatellite instability was not demonstrated in all 4 types of single-cell clones from 2008 and 2008/C13*5.25 cell lines. CONCLUSIONS: The present results indicate that there is no relation between mutation of mismatch repair gene and cisplatin resistance. But hMLH1-deficient ovarian cancer cells are more sensitive to Taxol or Topotecan in this study. The latter finding mandates the examination to assess the mutation of hMLH1 in tumor cells before treatment or at the time clinical resistance to cisplatin develops in ovarian cancer.

Anastomosis of Rabbit Uterine Horns using Neodymium: Yttrium Aluminum Garnet(Nd: YAG) Laser / 대한산부인과학회잡지

No abstract available.

Detection of c-K-ras Oncogene Point Mutations in Cancers of the Female Genital Tract / 대한부인종양콜포스코피학회잡지

It hae been well established that, specifi alterations in members of the ras gene family, H-ras, K-ras and N-ras, can convert them into active oncogenes. These alterations are either point mutations occurirg in either codon 12, 13 or 61, or alternatively, a 5- to 50-fold amplification of the wfld-type gene. Activated ras oncogenes have been found in a significant proportion of all turnors, but the incidence varies considerably with the tumor type : it is frequent (20~40%) in colarectal eancer and acute myeloid leukemia, but absent or preaent rarely in breast and atomach cancer. But the role of c-K-ras point mutatio in the development of cancers in the female genital tract has not been extensively studied. Polymerase chain reaction followed by gel electrophoresis was performed respectively using wild-type normal and specific point mutation primers{GGT->GAT, GGT->AGT, GGT->TGT and GGT->GTT) to detect, point, mutation of codon 12 of c-K-ras oncogene. The c-K-ras oncogene point mutation was confirmed by Southern blot hybridization using synthetic oligonucleatide probe. 3'-end Iabelled with digoxigenin -dUTP. With this method, the frequency of point mutation on codon 12 of c-K-ras oncogene was examined the tissues in 37 casea of ovarian cancer, 7 cases of endometrial cancer, 36 cases of the gestational trophoblastic tumor, 60 cases of cervical cancer. The relationship between the presence of a c-K-ras point mutation and clinicopathological characteristics of the female genital tract cancers were also analysed. The results were as follows; 1. The incidence of four point mutations on codon 12 of c-K-ras oncogene in 37 ovarian cancers was 45.9% (17/37) and distribution were 43.2% (16/37), 2.7% (1/37) and 0% (0/37) in GGT-->GAT, GGT-->AGT, GGT-->TGT, and GGT-->GTT, respectively. According to histological type, in ovarian cancers, The point mutation of K-ras oncogene waspositive in 45 % (10/22) of serous cystadenocarcinomas. The incidence of four point mutations on codon 12 among 37 patients with ovarian cancer according to histological type was 45.5 % (10/22) with serous cystadenocarcinoma, 57.1% (4/7) of mucinous cystadenocarcinoma. Comparing the positive rate of point mutations of K-ras oncogen among 37 patients with ovarian cancer with the clinical stage, point mutation was detected in 28.5% (2/7) of patients with stage I, 40.0% (2/5) with stage II, and 52.0% (13/25) with stage III/IV. There was no statistically significant increasement of point mutations with the advance of the clinical stage of ovarian cancer. Comparing the positive rate of point mutations of K-ras oncogen among 37 patients with ovarian cancer according to the histologic grade point mutation was detected in 50.0 % (2/4) 0f patients with grade I, 451.7 % (5/12) with grade II and 47.6 % (10/21) with grade III. 2. The incidence of point mutations of K-ras oncogen among 33 patients with ovarian cancer who were performed pelvic lymph node dissection was 57.1 % (12/21) of the patients with pelvic lymph node metastases and 16.7% (2/12) of the patients without pelvic lymph node metastases. There was statistically significant difference between the positive rate of c-K-ras point mutations and the pelvic lymph nodal status(P<0.05). 3. In 7 cases of endometrial cancer, positive rate of K-ras point was 42.8 % (3/7). Point mutations were also detected in 2 cases from 4 choriocarcinomas, but, the point mutation was only detected in 1 case from 60 cervical carcinomas. From these results, we may suggest that the point mutation on codon 12 c-K-ras oncogene are considered to be one of the important genetic change in the tumor formation and progression of ovarian of c-K-ras oncogene seems to be the one stop in the multistep process of tumor formation in ovarian cancer. Furthermore, the point mutation of c-k-ras gene could occur more frequently in the patients of ovarian cancer with pelvic lymph node metastases than in those without pelvic metastases, suggesting the orle in tumor progression. And we concluded that point mutation on codon 12 is comparable frequent in uterine endometrial carcinomas and have significance as an event that contributes to progrssion of endometrial cancers and choriocarcinoma, but cervical carcinoma do not appear to have c-K-ras point mutation in general. More studies will be necessary, but the detection of c-k-ras point mutation as the possibility of biological tumor marker to predict clinical outcome may be utilized in female malignancies.