Involvement of PI3K/AKT and MAPK Pathways for TNF-alpha Production in SiHa Cervical Mucosal Epithelial Cells Infected with Trichomonas vaginalis

Trichomonas vaginalis induces proinflammation in cervicovaginal mucosal epithelium. To investigate the signaling pathways in TNF-alpha production in cervical mucosal epithelium after T. vaginalis infection, the phosphorylation of PI3K/AKT and MAPK pathways were evaluated in T. vaginalis-infected SiHa cells in the presence and absence of specific inhibitors. T. vaginalis increased TNF-alpha production in SiHa cells, in a parasite burden-dependent and incubation time-dependent manner. In T. vaginalis-infected SiHa cells, AKT, ERK1/2, p38 MAPK, and JNK were phosphorylated from 1 hr after infection; however, the phosphorylation patterns were different from each other. After pretreatment with inhibitors of the PI3K/AKT and MAPK pathways, TNF-alpha production was significantly decreased compared to the control; however, TNF-alpha reduction patterns were different depending on the type of PI3K/MAPK inhibitors. TNF-alpha production was reduced in a dose-dependent manner by treatment with wortmannin and PD98059, whereas it was increased by SP600125. These data suggested that PI3K/AKT and MAPK signaling pathways are important in regulation of TNF-alpha production in cervical mucosal epithelial SiHa cells. However, activation patterns of each pathway were different from the types of PI3K/MAPK pathways.

Meconium peritonitis: prenatal diagnosis and postnatal outcome / 대한산부인과학회지

OBJECTIVE: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. METHODS: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. RESULTS: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. CONCLUSION: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.

One case of vulva metastasis from cervical squamous cell carcinoma / 대한산부인과학회지

Metastasis to the skin occurs rarely in gynecologic cancer. Although carcinoma of the cervix is the fifth most common malignancy in Korean women, cutaneous involvement originating from cervical cancer is unusual. Common pattern of occurrence is multiple nodule in abdomen, vulva, lower extremities. We report a case of metastasis from squamous cell carcinoma of cervix to vulva. The patient was diagnosed with cervical cancer IIA. The extensive skin lesion on the vulva occurred 3 months after neoadjuvant chemotherapy, radical hysterectomy and concurrent chemoradiation. We have experienced such a case and report the case with brief review of literatures.

Fetal ductus arteriosus constriction and heart failure following maternal cyclooxygenase-2 inhibitor ingestion: A case report / 대한산부인과학회지

We report a case of premature constriction of the fetal ductus arteriosus following maternal ingestion of a cyclooxygenase-2 (COX-2) inhibitor at 37 weeks' gestation. Fetal sonography at 38+2 weeks' gestation revealed tricuspid regurgitation, absent transpulmonary valve flow, right heart enlargement, and pericardial effusion. An immediate delivery resulted in a good postnatal outcome with dramatic improvement in the clinical and echocardiographic findings. Maternal exposure to Non-steroidal anti-inflammatory drugs (NSAIDs), especially late in gestation, can cause premature constriction of the ductus arteriosus, heart failure, and fetal death. Therefore, the use of NSAIDs late in gestation should be considered in limited cases with close fetal heart monitoring.

Prenatal diagnosis and clinical course of restrictive foramen ovale in otherwise normal heart / 소아과

PURPOSE: Premature narrowing of the foramen ovale is rare but serious clinical entity. Prenatal narrowing or obstruction of the foramen ovale shows symptoms such as right heart failure, fetal hydrops, triscupid regurgitation, left heart obstructive disease, and supraventricular tachycardia. This study aimed to assess the prenatal diagnosis and postnatal clinical course of restrictive foramen ovale in utero in otherwise normal heart. METHODS: The subjects were five patients diagnosed with restrictive foramen ovale in utero from January 2001 to June 2005 at Chungnam National University Hospital. The diagnostic criteria was defined when the maximum diameter in a 4-chamber view is less than 2.5 mm and there is a continuous doppler velocity at the foramen ovale of more than 0.6m/s. RESULTS: At the time of diagnosis of restrictive foramen ovale, gestation age was 34~37 wks, and chief complaints were fetal arrhythmia(2 cases), pericardial effusion, Ebstein anomaly and subaortic stenosis. Two cases which were diagnosed fetal hydrops and supraventricular tachycardia delivered by emergent cesarian section. Five cases were found to have right heart dilatation on echocardiogram after birth, but right heart dilatation became normalized at day 7 after birth and the clinical courses were not eventful. CONCLUSION: Identifying an obstructed foramen ovale in the fetus warrants the further search for additional cardiac and extracardiac anomalies, which may alter the prognosis. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.

Late postpartum eclampsia 11days after delivery without preeclampsia: A case report / 대한산부인과학회지

Eclampsia, defined as peripartum seizure activity commonly associated with hypertension, proteinuria and edema. Historically, eclampsia was believed not to occur more than 48 hours after delivery and late postpartum eclampsia was thought to be uncommon. However, recent evidence suggests that its incidence is increasing. In addition, clinical signs of late postpartum eclampsia may differ from that occurring during the pregnancy. In case of late postpartum eclampsia, headache and visual disturbance may precede seizure but classic preeclampsia signs as edema, proteinuria, and hypertension are not presented until shortly before seizure onset. So it should be needed that patient education about prodromal symptoms of late postpartum eclampsia, including headache, visual disturbance, and abdominal pain at the time of hospital discharge. We described a case of eclampsia occurring 11days after delivery without preeclampsia symptom including a review of the literature.

A case report of recurrent Meckel Gruber syndrome / 대한산부인과학회지

Meckel Gruber syndrome consisting of an occipital encephalocele, polycystic kidney disease and polydactyly is a rare autosomal recessive disorder with a recurrence risk of 25%. Targeted ultrasonography in late embryonic or early fetal stages of pregnancy has great importance in diagnosis and management of affected pregnancy in high risk groups due to incomplete genetic mapping of meckel syndrome gene (MKS). We present a case of prenatal diagnosis at 14 weeks' gestational age of Meckel Gruber syndrome in a woman, who experienced same disorder in her previous pregnancy.

Distribution and Role of Ovarian Follicle Macrophage in Rat Ovarian Follicular Atresia / 대한산부인과학회지

OBJECTIVE: Ovarian follicular atresia is initiated from ovarian granulosa cell apoptosis and macrophages exert their effects directly and/or indirectly on follicular atresia by phagocytosis of apoptotic bodies and secretion of various cytokines. In spite of the abundant data on ovarian macrophages, the presence of these cells within the follicles (i.e., among granulosa cells) remains controversial and the elimination methods of apoptotic bodies of atretic follicles, and the time and methods of penetration of macrophages into the follicles are not known completely. The aim of the present study is to demonstrate the presence of macrophage within the ovary as related to follicular atresia and the process of elimination of apoptotic granulosa cells by light and electron microscopy. METHODS: Using rat ovaries, immunohistochemical studies with rat macrophage monoclonal antibody ED1 for macrophages, and light and transmission electron microscopic observations were performed. RESULTS: In the rat, follicular atresia was initiated by the granulosa cell apoptosis which occured randomly within the all granulosa layers. Macrophages were observed within normal follicles, in antrum, granulosa and theca cell layers of atretic follicels, in interstium and in corpus luteum. Ultrastructurally, apoptotic granulosa cells showed characteristics, pyknotic nucleus and apoptotic body formation. Apoptotic bodies were eliminated by intact neighboring granulosa cells and macrophages. Intact granulosa cells ingested apoptotic bodies transiently, soon after they fell into the apoptosis. Finally, apoptotic bodies and degenerating oocytes were phagocytosed by macrophages. Macrophages entered the ovarian follicle at the time of initiation of granulosa cell apoptosis, and migrated with the progression of apoptosis. By elimination of theca cells, macrophages contributed the completion of follicular atresia. CONCLUSION: This study demonstrates both intact neighboring granulosa cells and macrophages in the elimination of apoptotic bodies in atretic follicles of the rat ovary. Macrophages are present within normal follicles, in atretic follicles such as antrum, granulosa and theca cell layers and in corpus luteum but are in different appearances according to their location in ovary. A number of macrophages appearing in atretic follicles and in corpora lutea suggest a role for macrophages in follicular atresia and corpus luteum differentiation. The function of macrophage according to their location in follicular development should be further studied.

PTEN and p53 Mutations in Endometrial Carcinomas

BACKGROUND: Endometrial carcinomas are pathogenetically classified into two major types; endometrioid carcinoma (EC) and serous carcinoma (SC). The most frequently altered gene in EC is the PTEN tumor suppressor gene (TSG). SC is usually associated with mutations in the p53 TSG. METHODS: To further determine the role of PTEN and p53 mutation in endometrial carcinogenesis, the analysis of 33 endometrial carcinomas, including 28 ECs and 5 SCs, for loss of heterozygosity (LOH) on 10q23 and for mutation in all 9 coding exons of PTEN and the 5-8 exons of p53, using SSCP-PCR methods was carried out. RESULTS: LOH was detected in at least one marker in 12 (54.5%) of 22 ECs, but in only one (20.0%) of 5 SCs. Somatic PTEN mutations were detected in 10 (35.7%) of 28 ECs. PTEN was altered in 67.9% of ECs and in 20.0% of SCs, including those with 10q23 LOH. No PTEN mutations were found among the SCs. Somatic p53 mutations were detected in 2 (7.1%) of 28 ECs and 3 (60.0%) of 5 SCs. CONCLUSIONS: PTEN gene alterations contribute to the pathogenesis of an endometrioid subtype of endometrial carcinoma, but not to the serous type. In contrast, p53 plays an important role in the pathogenesis of SCs.

Incidence of Congenital Anomalies and Diagnosis of Congenital Anomalies by Antenatal Ultrasonography / 대한산부인과학회잡지

OBJECTIVE: To determine the incidence and types of congenital anomalies and evaluate the efficiency of antenatal ultrasonography for detection of congenital anomalies METHODS: This was a retrospective study, undertaken on 157 cases with congenital anomalies among 5,554 delivered newborns at Chungnam National University Hospital from Jan. 1, 1998 to Dec. 31, 2002. For statistical evaluation, Chi-square test were used. RESULTS: Among the total 5,554 newborns, the overall incidence of congenital anomalies was 2.8%. The incidence of congenital anomalies in birth weights less than 2,500 gm was 9.2% which was 7.5 times higher than that of birth weights more than 2,500 gm. The incidence of congenital anomalies in stillbirth was 19.3% which was 8.2 times higher than that of the live birth. When classified according to the type of congenital anomalies, the incidence of congenital anomalies were 26.5%, 21.0%, 19.8%, 13.0%, 7.4%, 6.2%, 3.7%, and 2.5% respectively in urogenital system, central nervous system, digestive system, cardiopulmonary system, dermatologic system, musculoskeletal system, chromosomal anomaly syndrome, and fetal tumor. Among 157 cases of congenital anomaly babies, anomaly babies were detected antenatally by ultrasonographic examination in 122 cases, and then the rate of antenatal ultrasonographic detection was 77.7%. CONCLUSION: The overall incidence of congenital anomalies was 2.8%. The most common congenital anomalies were urogenital anomalies. The rate of antenatal ultrasonographic detection for congenital anomalies was 77.7%.

Clinical and Cytogenetic Analysis of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To analyze the indications, clinical features, cytogenetic results and complications of amniocentesis and to determine the efficacy of antenatal genetic amniocentesis. METHODS: We analyzed retrospectively maternal age, gestational age, indications, transplacental puncture, frequency, discoloration of amniotic fluid, karyotype and complications in 325 cases of prenatal genetic amniocentesis performed at Chungnam National University Hospital from January 2000 to December 2002. RESULTS: The most common age group was from 30 to 34 (31.4%) and mean age was 32.7 years old. 85.3% of cases were performed at 16th-20th gestational weeks. Abnormal maternal serum markers were the most common indication of amniocentesis (56.0%) and the second most common indication was maternal age over 35 (33.2%). Abnormal karyotypes were found in 12 cases (3.6%) and normal variants were 21 cases (6.5%). Numerical aberration were 9 cases (2.7%) and structural aberration were 3 cases (0.3%). Among the autosomal aberrations, Down syndromes were 5 cases and Edward syndrome was 1 case. Among the sex chromosomal aberrations, 47,XXX were 2 cases and Turner syndrome was 1 case. As the increasing maternal age, the incidence of abnormal karyotype was increased. Procedure-related complications occurred in 11.7% of cases and fetal loss rate was 7.4%. No significant associations were found between procedure-related complications and maternal age, gestational age, transplacental puncture, frequency, discoloration of amniotic fluid, and antibiotic treatment. CONCLUSION: Amniocentesis is useful for prenatal genetic diagnosis in pregnancies with increasing risk of chromosome aberrations, such as advanced maternal age, abnormal maternal serum markers or abnormal US findings. Further studies are necessary to identify risk factors of complications after invasive procedure.

Expression of the Tissue Inhibitor of Matrix-Metalloproteinase (TIMP-2) in Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The present study was conducted to evaluate the tissue inhibitor of matrix-metalloproteinase (TIMP-2), which leads to tumor proliferation, invasion and metastasis and which can be used as a prognostic factor for cervical carcinoma, and to correlate TIMP-2 with recurrence in cervical carcinoma. METHODS: Thirty-three cases of cervical carcinoma and ten control cervices were analysed for expression of TIMP-2 by immunohistochemical staining. Results were analysed for possible correlation with prognostic factors. RESULTS: Lymph node metastasis, lymphovascular invasion, and recurrence groups showed a lower expression tendency of TIMP-2 in tumor cells (0.67 vs 0.88, 0.77 vs 0.93, 0.78 vs 0.91) (p>0.05). However, there was no statistical significance in the correlation of TIMP-2 expression with tumor variables. On the other hand, in stromal cells, deep invasion (>or=5 mm), squamous cell carcinoma groups showed a higher expression tendency of TIMP-2 (0.80 vs 0.67, 0.74 vs 0.40) (p>0.05) but, there was no statistical significance. However, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells (0.33 vs 0.83) (p<0.05). CONCLUSION: In spite of no statistically significant correlation in tumor cells, recurrence group showed a significantly lower expression of TIMP-2 in stromal cells. Therefor there was an inverse correlation between expression of TIMP-2 in stromal cell and recurrence. These results indicate that expression of TIMP-2 in stromal cells is closely correlated with the recurrence of cervical carcinoma.

Comparison of Apoptosis and Bcl-2 Expression in Normal Pregnancy, Pregnancy Induced Hypertension and Intrauterine Growth Restriction / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the incidence of apoptosis and expression of bcl-2 in the placenta of normal pregnancy, Pregnancy Induced Hypertension, and Intrauterine Growth Restriction. METHODS: Placenta samples were collected from 15 cases of normal full-term pregnancies, 15 cases of second trimester pregnancies, 17 cases of Pregnancy Induced Hypertension, and 13 cases of Intrauterine Growth Restriction. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Expression of bcl-2 was confirmed by using immunohistochemical stain in relation to apoptosis. RESULTS: 1. In TUNEL staining, quantification of apoptosis was 1.05 in 2nd trimester (n=15), 3.65 in pregnancy induced hypertensive pregnancy (n=17), 2.92 in intrauterine growth restrictive pregnancy (n=13) and 1.93 in normal full-term pregnancy (n=15). The incidence of apoptosis was significantly higher in placental tissues from full-term pregnancies than second trimester pregnancies (p0.05, t test), and between intrauterine growth restriction and normal full-term pregnancy (p>0.05, Mann-Whitney U test). CONCLUSION: These data suggest that apoptosis increases with gestational age, and in pathophysiologic states such as pregnancy induced hypertension and intrauterine growth restriction, and that bcl-2 expression is lower with gestational age.

Comparison of Apoptosis and Bcl-2 Expression in Normal Pregnancy, Pregnancy Induced Hypertension and Intrauterine Growth Restriction / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the incidence of apoptosis and expression of bcl-2 in the placenta of normal pregnancy, Pregnancy Induced Hypertension, and Intrauterine Growth Restriction. METHODS: Placenta samples were collected from 15 cases of normal full-term pregnancies, 15 cases of second trimester pregnancies, 17 cases of Pregnancy Induced Hypertension, and 13 cases of Intrauterine Growth Restriction. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Expression of bcl-2 was confirmed by using immunohistochemical stain in relation to apoptosis. RESULTS: 1. In TUNEL staining, quantification of apoptosis was 1.05 in 2nd trimester (n=15), 3.65 in pregnancy induced hypertensive pregnancy (n=17), 2.92 in intrauterine growth restrictive pregnancy (n=13) and 1.93 in normal full-term pregnancy (n=15). The incidence of apoptosis was significantly higher in placental tissues from full-term pregnancies than second trimester pregnancies (p0.05, t test), and between intrauterine growth restriction and normal full-term pregnancy (p>0.05, Mann-Whitney U test). CONCLUSION: These data suggest that apoptosis increases with gestational age, and in pathophysiologic states such as pregnancy induced hypertension and intrauterine growth restriction, and that bcl-2 expression is lower with gestational age.

Morphological Study on the Radiation-induced Follicular Atresia and the Follicular Macrophage / 대한산부인과학회잡지

OBJECTIVE: It is well known that X-ray induces follicular atresia, but the exact mechanism of atresia is not still unveiled completely. In addition, the role of macrophage related with clean-up the dead granulosa cells and other functions within the ovarian follicle is emphasized recently. The aim of this study is to assess the radiation-induced morphological changes of ovarian follicles and follicular macrophages. METHODS: 8 Gy X-ray irradiated on the 3-week old rats (Sprague-Dawley strain), sacrificed at 6, 12, and 24 hours after irradiation, and performed morphological studies with light and transmission electron microscopy, TUNEL, and macrophage immunohistochemistry. RESULTS: Follicular atresia increased significantly (p<0.01) at 6 hours after X-irradiation, and it was decreased significantly (p<0.01) at 12 and 24 hours after irradiation. X-ray induced chromatin condensation in the nucleus and nuclear fragmentation of granulosa cells, which were the typical features of apoptosis. Apoptotic granulosa cells were phagocytosed by the neighboring normal granulosa cells and the macrophages. During atresia of follicles, radioresistant granulosa cells were found in some follicles, which showed similar features morphologically with the granulosa cells of normal follicles. Macrophages were found both within the antrum and at the follicular granulosa layer. CONCLUSION: X-radiation induced follicular atresia by means of granulosa cell apoptosis, and radioresistant granulosa cells which have similar features morphologically with the granulosa cells of normal follicles were observed in some follicles. And the macrophages which phagocytose the apoptotic granulosa cells were located within the follicular antrum and at the follicular granulosa layer.

Loss of Heterozygosity in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: Endometriosis is a very common gynecological condition in which tissue similar to endometrium proliferates at sites outside the uterine cavity. Although it generally remain a benign condition, malignant transformation has been documented, and it is commonly found in association with endometrioid subtype ovarian carcinoma. In order to identify the genomic change in those areas possibly involved in the pathogenesis of endometriosis, we performed LOH analysis. METHODS: Twenty seven cases of endometriosis were analyzed for the detection of LOH using 5 microsatellite markers. LOH analysis was performed by PCR, capillary electrophoresis and gene scan analysis using DNA from sections of tumor and normal tissue pairs. RESULTS: Twenty two of 27 (81.5%) cases demonstrated LOH at one or more loci. The frequency of LOH was 37.0% (D18S69), 25.9% (D22S274), 14.8% (D22S283), 7.4% (D6S286), 7.4% (D13S160). CONCLUSION: The frequencies of LOH was increased in higher stage of endometriosis. Most notable findings were found at chromosome 18 and 22 loci (D18S69, D22S274). These region might involve the some candidate genes closely related with the pathogenesis of endometriosis.

Cyclooxygenase-2 Expression and it's Usefulness as a Prognostic Factor in Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: Recent epidemiologic studies indicate that use of nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase (COX) activity reduce the risk of colorectal cancer. COX-2 expression has been identified in cancers of many organs. There are also many reports that identify COX-2 expression and its possible role in tumorigenesis in cervical cancers. This study was performed to determine wether COX-2 is expressed in cervical cancer and to evaluate the value of COX-2 as a predictor of treatment results. PATIENTS AND METHODS: The study included 34 cases of stage IB to IVA cervical cancer and 22 cases of normal cervical specimens obtained through biopsy or surgery at the Chungnam National University Hospital. A COX-2 immunohistochemical stain was performed on these specimens. RESULTS: There was a statistically significant difference of COX-2 positivity between the cervical cancer group and a control group (p=0.01, Fisher's exact test), between the well controlled group and the treatment failure group (p=0.00, Fisher's exact test) and among stages (p=0.01, linear-by-linear association). The COX-2 positive group had a mean overall survival time of 55 months compared with 80 months for COX-2 negative group (p=0.00, log-rank test). The Locally advanced cervical cancer group (stage IIB-IV A) had a mean overall survival time of 46 months compared with 84 months for early stage disease group (stage IB, II A) (p=0.00, log-rank test). A Cox regression model showed that COX-2 positivity and clinical stages retained independent roles in predicting treatment results and prognosis. CONCLUSION: Evaluation of COX-2 expression in cervical cancer patients is valuable for predicting the treatment results and prognosis.

Placental apoptotic change in 2nd trimester and full-term of normal pregnancies / 대한산부인과학회잡지

OBJECTIVE: The study aims were to demonstrate apoptosis in the placenta of normal pregnancy, and to identify its change and quantify its incidence by gestational age. METHODS: Placenta samples were collected from 25 normal full-term pregnancies and 20 second trimester pregnancies undergoing termination due to medical and social reasons. Hematoxylin and eosin staining and TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) staining were used to quantify the incidence of apoptosis and the electron microscopy was used to confirm it. Mann-Whitney U test and ANOVA test were used for statistical analysis. RESULTS: 1. Apoptosis was demonstrated by variable cytopathologic methods, and especially TUNEL staining and electron microscopy are found to be confirmatory methods. 2. In TUNEL staining, quantification of apoptosis was as follows: 2nd trimester (n=20) 1.05+/-0.69, full- term (n=25) 1.92+/-1.00. The incidence of apoptosis was significantly higher in full-term than in 2nd trimester (p0.05, Mann-Whitney U test). 4. There was no statistical significance in the incidence of apoptosis by maternal age, parity, cause of termination during 2nd trimester, and mode of delivery in each group. 5. In the electron microscopy, apoptotic cells were observed to have membrane blebbing, loss of microvilli, chromatin condensation and localization in the border of nuclear membrane, and cell shrinkage and increase in granularity. This method was conformatory in identifying apoptosis. CONCLUSION: Placental apoptosis increased significantly with increased gestational age, and this result suggests that it may play a role in the normal development and aging of the placenta.

Prophylactic antibiotics in elective cesarean section / 대한산부인과학회잡지

OBJECTIVE: To evaluate effectiveness of short-course administration of prophylactic antibiotics in elective cesarean section compared with multiple, long-course administration. METHODS: Forty women undergoing elective cesarean section had prophylactic antibiotics administration preoperatively and 2 times more within 24 hours after operation. Forty women was control group who had antibiotics administration postoperatively 5 or 6 times with multiple regimens and 7 days more per oral. Postpartum complications including febrile morbidity, endometritis, wound infection, urinary tract infection were recorded, as were the duration of hospital stay and need for therapeutic antibiotics. RESULTS: Postpartum complications including febrile morbidity, endometritis, wound infection and urinary tract infection had no difference between two groups significantly. Also, their hospital stay had no difference significantly. CONCLUSION: Prophylactic and short-course antibiotics administration in elective cesarean section is considered to have no difference in comparison with multiple, long-course post-operative administration. Short- course prophylactic antibiotics administration will reduce side effect of drugs and resistance. Also it will provide better cost effectiveness.

A Case of Phlegmon caused by Chronic Pelvic Inflammation mimiking Pelvic Malignancy / 대한산부인과학회잡지

Pelvic inflammatory disease (PID) is a common disease associated with gynecologic infection, occurring mainly in fertile women. We report a case of phlegmon caused by chronic PID mimicking pelvic malignancy in a 39-year-old woman. The patient suffered from chronic pelvic pain, intermittent fever, and dysuria. A palpable lower abdominal mass was associated with progressive weight loss. A pelvic MRI revealed a 9x8x7cm sized, ill-defined soft tissue mass in the right pelvic cavity. On exploratory laparotomy, the pelvic mass was severly adhesed to the small intestine, mesentery, and urinary bladder. An incisional biopsy of the pelvic mass was performed. Histologically, the pelvic mass was composed of inflammed fibrous tissue with granulation tissue proliferation. The patient was treated with metronidazole and ciprofloxacin for two weeks. Fever and abdominal pain were relived. On a follow up abdomino-pelvic CT, the pelvic mass was not visible. Awareness of such an unusual case of chronic PID mimicking pelvic malignancy will facilitate a more accurate diagnostic approach for a variety of pelvic mass lesion.