Comparison of cell growth suppression in SiHa cervical carcinoma cell line by human papillomavirus type 16 E6/E7 siRNAs / 대한산부인과학회지

OBJECTIVE: Human cervical cancer is caused by the high-risk types of human papillomavirus (HPV) such as HPV16, which possess the E6 and E7 oncogenes, whose expressions are a prerequisite for cancer development. We performed this study to compare the efficacy of antitumor activity by HPV siRNA which silences only E6 or both E6/E7. METHODS: We transfected siRNA 377 (HPV16 E6 siRNA), siRNA 3 (HPV16 E6 siRNA), and siRNA 198 (HPV16 E7 siRNA) into SiHa cell line (siRNA 377 silences only E6, and siRNA 3 and siRNA 198 silence both E6 and E7). We experimented cell counts and morphologic changes 24 and 48 hours after transfection and expressions of HPV16 E6/E7 mRNA by RT-PCR. RESULTS: siRNA 377, siRNA 3, and siRNA 198 suppressed the cell growth. siRNA 3 and siRNA 198 were more potent than siRNA 377 in cell growth suppression. siRNA 377 knocked down the expression of E6 mRNA, and both siRNA 3 and siRNA 198 knocked down the expression of E6/E7 mRNA. CONCLUSION: Our results suggest that simultaneous suppression of E6 and E7 was more potent than E6-specific suppression in cancer cell growth.

A case of lymphoepithelioma-like carcinoma of the uterine cervix / 대한산부인과학회지

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix, also called lymphoepithelioma or medullary carcinoma, is a very rare variant of squamous cell carcinoma. Histologically, the tumor is characterized by groups and nests of poorly differentiated tumor cells with abundant cytoplasm and ill-defined cell borders, surrounded by an intense chronic inflammatory infiltrate. Epstein-Barr virus (EBV) may be involved in the development of LELC but the exact role remains unclear. The relationship between human papillomavirus (HPV) and LELC of the uterine cervix has also not been reported. The prognosis of LELC of the uterine cervix seems to be better than that of cervical squamous cell carcinoma. We report a case of LELC of the uterine cervix with a brief review.

A case of lymphoepithelioma-like carcinoma of the uterine cervix / 대한산부인과학회지

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix, also called lymphoepithelioma or medullary carcinoma, is a very rare variant of squamous cell carcinoma. Histologically, the tumor is characterized by groups and nests of poorly differentiated tumor cells with abundant cytoplasm and ill-defined cell borders, surrounded by an intense chronic inflammatory infiltrate. Epstein-Barr virus (EBV) may be involved in the development of LELC but the exact role remains unclear. The relationship between human papillomavirus (HPV) and LELC of the uterine cervix has also not been reported. The prognosis of LELC of the uterine cervix seems to be better than that of cervical squamous cell carcinoma. We report a case of LELC of the uterine cervix with a brief review.

Two cases of primary malignant lymphoma of the uterine cervix / 대한산부인과학회지

Primary malignant lymphoma of the uterine cervix is very rare. Lymphomas account for 3.5% of all malignant tumors in the females. Approximately, 25% of all malignant lymphomas arise from extranodal sites, most frequently from gastrointestinal tract and skin. Although the incidence of systemic non-Hodgkin's lymphoma (NHL) and extranodal NHL has increased in recent decades, only 1 to 1.5% arises from female genital tract. Primary pelvic sites include ovary, which is the most common site, uterine corpus, cervix, vagina, and vulva. Primary cervical lymphomas account for 0.12~0.6% of all extranodal lymphomas. However, there is still no consensus on the management of cervical lymphomas due to low incidence of the disease and limited experience in the literature. We experienced two cases of primary malignant lymphoma of the uterine cervix. A 41-year-old woman, Ann Arbor stage IE, was treated with laparoscopically assisted vaginal hysterectomy and both salpingo-oophorectomy and 4 cycles chemotherapy. A second case was a 73-year-old postmenopausal woman, Ann Arbor stage III, received five courses chemotherapy without any surgery. In this article, two cases of uterine cervical lymphoma are presented with a review of the available literature.

Neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: This study was aimed at comparison of women with advanced ovarian cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery with those treated conventionally with primary debulking surgery followed by cytotoxic chemotherapy (conventional group). METHODS: Between January 1998 and December 2005, 11 patients with advanced epithelial ovarian cancer were treated by NAC followed by debulking surgery and 20 patients were treated by primary cytoreductive surgery followed by cytotoxic chemotherapy conventionally. The files were reviewed retrospectively. RESULTS: The mean age was 54.8+/-11.6 in NAC and 53.0+/-11.9 years in conventional group. 10 cases were serous adenocarcinoma in NAC group and 16 cases were serous, 1 was mucinous and 2 cases were endometrioid type in conventional group (Table 1). Mean courses of NAC were 3 cycles (range 1-4) and carboplatin and paclitaxel regimen was most common (Table 2). After NAC, 2 complete responses (18.2%) were achieved, 4 patients (36.4%) achieved a partial response, and 5 (45.5%) had no response or progressive disease. At debulking surgery, no pathological complete response was noted, and residual ovarian cancer was present in all cases. The optimal surgery (residual tumor <2 cm) was obtained in 9 cases (81.8%) of NAC and 5 cases (25.0%) of conventional group (Table 3). The mean estimated blood loss was 604.54+/-178 ml (range 400-1,000 ml) in NAC group and 752.5+/-335 ml (range 400-2,000 ml) in conventional group , blood transfusion 2.2 pints (range 0-5 pints) in NAC and 4.6 pints (range 1-19 pints) in conventional group, the mean operative time was 244.54+/-108 minutes in NAC group and 251.5+/-94.5 minutes in conventional group, mean intensive care unit stay was 1.6 days (range 0-3 days) in NAC and 2.5 days (range 0-13 days) in conventional group, and mean hospital stay was 17.36+/-8.97 days (range 7-42 days) in NAC and 24.45+/-11.7 days (range 10-48 days) in conventional group respectively (Table 4). There were no significant statistical differences in two groups except hospital stay (p=0.04). There were no significant statistical differences of disease-free and overall survival in two groups (Fig 1&2). CONCLUSION: The rate of optimal debulking surgery, blood loss, operative time, disease-free and overall survival, excluding the length of hospital stay, showed no significant statistical differences in both groups. Even though we might have statistical shortage because we were able to get only limited cases to show meaningful results, there is enough validity of conducting prospective clinical research using NAC since the overall survival rate in both groups showed no significant difference.

A Case of Primary Ovarian Fibrosarcoma / 대한산부인과학회지

Fibrosarcoma of the ovary is an exceedingly rare primary ovarian stromal tumor, which has a poor prognosis. Fibrosarcoma may arise de novo or as a result of malignant change in a benign fibromatous or fibrothecomatous tumor of the ovary. There are only about 30 cases in the literature reported within past three decades, showing the extreme rarity of these tumors. We report a case of primary ovarian fibrosarcoma with a review of the available literature.

Clinical Analysis of Uterine Leiomyoma with Increased Mitotic Activity / 대한산부인과학회지

OBJECTIVE: To evaluate clinical-pathological aspects of uterine smooth-muscle tumors with a pathological diagnosis of uncertain malignant potential or leiomyomas with increased mitotic activity. METHODS: We reviewed the charts and pathological records of twenty seven patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10HPF (High power fields) and without cytological atypia or necrosis retrospectively. RESULTS: The patients were 29-60 (mean 41.8+/-6.8) years old and mean parity was 1.7+/-0.9. None of the patients had used any hormones preoperatively. The size of the myomatous tumors ranged from 2 to 23 cm (mean 7.1+/-4.6 cm). On gross examination all tumors appeared as typical leiomyomas. Twenty were intramural and 7 were submucous leiomyomas. The mitotic counts ranged 5-9/10 HPF (mean 6.0+/-1.2/10 HPF). Cytological atypia or necrosis were absent. The histological phase of the endometrium could be evaluated in 18 patients. Of these, ten had secretory-phase endometrium and proliferative endometrium was present in eight patients. Hysterectomy was performed in 20 patients with intramural leiomyoma, and myomectomy was in 7 patients under diagnosis of submucosal type. Postoperative follow-up periods ranged 5-94 months (mean 37.0+/-22.6 months). All patients were alive without evidence of recurrence or metastasis. CONCLUSION: Leiomyomas containing from five to nine mitotic figures per 10 HPF, without cellular atypia or necrosis, should be regarded as benign. Hysterectomy need not autonomically be done, as follow-up is a viable alternative. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.

The Safety of Incidental Appendectomy during Total Abdominal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To evaluate the safety of the incidental appendectomies in women who undergo total abdominal hysterectomies for benign diseases. METHODS: This was a retrospective case-controlled study of patients who did (n=54) or did not (n=70) undergo incidental appendectomies at the time of an total abdominal hysterectomy between January 2002 and December 2003. Data were obtained about operation time, the number of days with nothing by mouth, the length of hospital stay (LOS), postoperative complications and pathology of appendix. Data were analyzed using student t-test. RESULTS: 1) There was no significant difference between two groups in operation time. The mean time was 120.0+/-23.8 in incidental appendectomy group and 112.5+/-23.9 minutes in control group. 2) There was no significant difference between two groups in the days with nothing by mouth. The mean was 1.06+/-0.23 in incidental appendectomy group and 1.03+/-0.17 days in control group. 3) There was no significant difference between two groups in the length of hospital stays. The mean was 7.34+/-0.68 in incidental appendectomy group and 7.14+/-1.15 days in control group. 4) There were no significant differences between two groups with respect to the post operative complications; fever, wound infection, stump disruption, and postoperative bleeding. 5) Seventy-six percent of the histologic specimens were abnormal, with fecalith being most common, and there were three cases of acute appendicitis. CONCLUSION: An incidental appendectomy at the time of hysterectomy does not increase operation time, the days with nothing by mouth, LOS, and postoperative complication rates. The incidental appendectomies during total abdominal hysterectomy may be safe procedures.

A Case of Leiomyoma of the Ovary / 대한산부인과학회지

Leiomyoma arising primarily in the ovary is a rare tumor, accounting for only 1% of benign ovarian neoplasms. About 50 cases have been reported in the literature to date. Most cases are asymptomatic and this benign neoplasm is usually found incidentally on routine pelvic examination, at surgery, or at autopsy. We present a case of ovarian leiomyoma in 39-year-old woman which has been experienced in our hospital with brief review of literature.

Two Cases of Pregnancy-associated Breast Cancer / 대한산부인과학회잡지

Pregnancy-associated breast cancer is defined as that occurring during pregnancy or within 1 year after delivery. The incidence of pregnancy-associated breast cancer is 0.2% to 3.8%. Tenderness, engorgement, increased size and increased prominence of the glandular tissue during pregnancy and lactation make mammography and clinical breast examination uncomfortable for the patient and less accurate for the detection of an abnormal breast mass. Pregnancy-associated breast cancer tends to be diagnosed at a more advanced stage, with an attendant adverse prognosis, than in women who are not pregnant or lactating. So physicians should perform a thorough breast examination at the first prenatal visit and maintain a high index of suspicion for cancer. We experienced 2 cases of pregnancy-associated breast cancer patients and reported these cases with a brief review of literature.

A Clinical Analysis of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To report our experience with laparoscopically assisted vaginal hysterectomy (LAVH) and evaluate the advantages of LAVH. This is a retrospective study. METHODS: From Jan. 2001 to Aug. 2002, 204 LAVHs were performed at the Department of Obstetrics and Gynecology, Our Lady of Mercy Hospital, The Catholic University of Korea. We studied the results with regard to the age, parity, previous abdominal surgery, surgical indications, operation time, weight of uterus, change of hemoglobin, hospital stay, concomitant procedures, and complications. RESULTS: The mean age was 43.9+/-6.4 years. The mean parity was 2.1+/-1.3. Tubal ligation was most common previous abdominal surgery. As a surgical indication, leiomyoma (52.9%) and adenomyosis (33.3%) were more common indications than any other gynecological problem. The mean operation time was 85.7+/-22.4 minutes. The mean uterine weight was 206.2+/-103.7 g. The mean hemoglobin change was 1.2+/-0.7 g/dl. The mean hospital stay was 3.3+/-0.8 days. Unilateral salpingoophorectomy was most common operation as concomitant procedure. Surgical complication rate was 3.4%. CONCLUSION: LAVH is a safe and effective alternative to abdominal hysterectomy with advanced technologic development in laparoscopic instruments and skills.

Methotrexate for Treatment of Tubal Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate value of methotretrexate (MTX) in the treatment of tubal pregnancy. METHODS: 28 patients with unruptured tubal pregnancy were treated alternately with four doses of intramuscular MTX (1.0 mg/kg) and four doses of intramuscular citrovorum factor (0.1 mg/kg). Patients considered eligible for MTX treatment of tubal pregnancy were those with unruptured tubal pregnancy

A Case of Multiple Primary Malignancy / 대한산부인과학회잡지

Multiple primary cancer means that more than two cancers are independently developed in one individual. The frequency of multiple primary neoplasm is increasing as a result of the lengthening average lifetime, progress in cancer screening technique, and improved cancer therapy. Gynecologic malignancies are especially prone to associated with primary neoplasms elsewhere. The frequency of multiple primary cancers was significantly higher in patients with uterine corpus cancer than in those suffering from cervical cancer. This case has different cell types of cancer in uterine cervix, thyroid and colon simultaneously. So, we report the case with a brief review of literatures.

Epidemiologic Characteristics and DNA Sequencing of SRSV Causing Gastroenteritis Outbreak in Two Elementary School / 감염과화학요법

BACKGROUND: Small round structured virus (SRSV) is one of the common etiologic agents of viral gastroenteritis in childhood. However, SRSV has not easily been detected in many diarrheal outbreaks. Therefore, we experienced simultaneous outbreak of SRSV enteritis in two elementary schools, therefore, we analyzed the result of the surveillance. METHODS: We interviewed the pupil of two schools and questioned their demographic data, presence of gastrointestinal symptoms, contact with symptomatic persons within the last two weeks, and dietary history within the last one week in school. The specimens of the symptomatic pupil were collected for identification of bacteria (Shigella spp, Salmonella spp, E.coli O157 : H7) and viruses (Norwalk agent, SRSV, adenovirus, and astrovirus). RESULTS: The number of symptomatic patients was 193 (193/2843, 6.8%) and the distribution of symptom onset was unipolar. Frequent symptoms of the patients were abdominal pain (176/193, 91.2%), headache (111/193, 57.5%), vomiting (102/193, 52.8%), diarrhea (83/ 193, 43.0%), febrile sense (79/193, 40.9%), nausea (73/193, 37.8%), chilling (49/193, 25.4%), and tenesmus (8/193, 4.1%). We identified SRSV in 9 cases by PCR method, and analyzed the RNA polymerase gene by DNA sequencing; 2 genogroup (Genogroup I, II) and 3 genotype. CONCLUSION: We confirmed SRSV enteritis with different genotypes in two concurrent outbreaks. DNA sequencing and comparison of genotype among the isolated SRSV in near future are be necessary

Epidemiologic Characteristics and DNA Sequencing of SRSV Causing Gastroenteritis Outbreak in Two Elementary School / 감염과화학요법

BACKGROUND: Small round structured virus (SRSV) is one of the common etiologic agents of viral gastroenteritis in childhood. However, SRSV has not easily been detected in many diarrheal outbreaks. Therefore, we experienced simultaneous outbreak of SRSV enteritis in two elementary schools, therefore, we analyzed the result of the surveillance. METHODS: We interviewed the pupil of two schools and questioned their demographic data, presence of gastrointestinal symptoms, contact with symptomatic persons within the last two weeks, and dietary history within the last one week in school. The specimens of the symptomatic pupil were collected for identification of bacteria (Shigella spp, Salmonella spp, E.coli O157 : H7) and viruses (Norwalk agent, SRSV, adenovirus, and astrovirus). RESULTS: The number of symptomatic patients was 193 (193/2843, 6.8%) and the distribution of symptom onset was unipolar. Frequent symptoms of the patients were abdominal pain (176/193, 91.2%), headache (111/193, 57.5%), vomiting (102/193, 52.8%), diarrhea (83/ 193, 43.0%), febrile sense (79/193, 40.9%), nausea (73/193, 37.8%), chilling (49/193, 25.4%), and tenesmus (8/193, 4.1%). We identified SRSV in 9 cases by PCR method, and analyzed the RNA polymerase gene by DNA sequencing; 2 genogroup (Genogroup I, II) and 3 genotype. CONCLUSION: We confirmed SRSV enteritis with different genotypes in two concurrent outbreaks. DNA sequencing and comparison of genotype among the isolated SRSV in near future are be necessary

Autologous blood transfusion in the third trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVE: Preoperative autologous blood donation aims at avoiding the risks associated with exposure to allogenic blood and transfusion related diseases such as AIDS and hepatitis. While its use is frequent in adult patients with elective surgery, it is still uncommon in pregnant women because its safety has not been established for mother and fetus. The aim of this study is to determine the safety and utility of autologous blood donation in the third trimester of pregnancy. METHODS: In this study, sixteen pregnant women with placenta previa, Rh negative or huge myoma underwent 24 phlebotomies according to an autologous transfusion program. Phlebotomies were performed at an average gestational age of 36+4 weeks (range 34-41 weeks). Maternal vital sign and fetal heart rate were monitored before, during and after phlebotomy. Hematocrit was statistically evaluated by paired t-test. RESULTS: During the phlebotomy, there was no remarkable change in fetal heart rate except one case with temporary fetal tachycardia. Furthermore, changes in mean maternal diastolic blood pressure and pulse rate were not noted except one case with mild dizziness and diaphoresis. Change in mean maternal hematocrit between the initial donation and admission day for delivery was not statistically significant (P>0.05). The average interval from last donation to delivery was 9.8 day (2-20 day). Fetal outcomes were good in all cases. CONCLUSION: We concluded that preoperative autologous blood donation in pregnant woman in third trimester is safe for mother and fetus. So, if pregnant woman do not want to receive allogeneic transfusion, autologous blood transfusion might be the alternative method.

A Case of Squamous Cell Carcinoma of Bartholin's Gland / 대한산부인과학회잡지

Carcinomas of Bartholin's gland are rare tumors that account for less than 1% of all gynecological malignancies. Two major histological types, squamous cell carcinoma and adenocarcinoma, account for 80% to 90% of primary cases. The remainders are adenosquamous carcinoma, adenoid cystic carcinoma and so on. We experienced a case of squamous cell carcinoma of the Bartholin's gland managed by wide local excision and chemotherapy with cisplatin and 5-fluorouracil (5-FU). We present this case with a brief review of the literatures.

Restoration of Wild-Type p53 by Adenovirus-Mediated Gene Transfer May Enhance the Therapeutic Efficacy of Chemotherapy in Human Ovarian Cancer Cells / 대한부인종양콜포스코피학회잡지

OBJECTIVE: In an effort to develop a more effective therapeutic strategy for ovarian cancer, we examined whether the restoration of the wild-type p53 gene can enhance the therapeutic effect of chemotherapy. METHODS: In this study, Ov-ca-2774 cells, which are known to have p53 point mutation and cisplatin-resistance, were selected and currently used chemotherapeutic agents including cisplatin, carboplatin, paclitaxel, etoposide, topotecan, and doxorubicin were added concurrently or sequentially with adenovirus-mediated p53 gene transfer (Ad5CMV-p53). RESULTS: Transfer of the wild-type p53 cDNA gene into Ov-ca-2774 cells showed 55% cell killing in vitro at a multiplicity of infection (MOI) of 40. Although the combination of carboplatin or paclitaxel followed by p53 gene transfer with an interval of 48 h manifested no enhanced cell killing compared with cells infected with Ad5CMV-p53 alone, the other combinations of chemotherapeutic agents and p53 gene transfer resulted in 15% to 37% further cell killing (P<0.05). Furthermore, p53 gene transfer followed by doxorubicin with an interval of 24 h and concurrent combination of etoposide with p53 gene transfer showed significant difference in cell killing in contrast to the other combination strategies in the respective chemotherapeutic agent exposure groups (P<0.05). CONCLUSION: Our data demonstrated that combination of p53 gene transfer and chemotherapeutic agents had higher cell killing than either of these two modality alone.

A Case of Hantavirus Pulmonary Syndrome Complicating Pregnancy / 대한산부인과학회잡지

Hantavirus infection occuring during pregnancy is rarely progressing to adult respiratory distress syndrome (ARDS), which is accompanied by thrombocytopenia, leukocytosis, fever, oliguria, aggravation of bleeding, hematuria, lactacedemia. Pregnancy may have an unfavorable impact on the pathophysiologic characteristics of ARDS. The high oxygen demands of pregnancy are unable to be matched by oxygen delivery in ARDS and may predispose the patient to multiple organ failure, as well as fetal oxygen deprivation. We present the case with hantavirus pulmonary syndrome complicating pregnancy.

A Case of Uterine Prolapse during Pregnancy / 대한주산의학회잡지

The incidence of uterine prolapse during pregnancy is rare. A 34-year-old G3P1 was initially presented at 16 weeks 5days of gestation with a prolapse of the uterine cervix. The cervix was edematous and protruding beyond introitus. Management included bed rest, and the patient was discharged after several days with a vaginal pessary to help maintain cervical placement. At 35 weeks of gestation, the patient did not experience any further prolapse after the removal of the pessary. Pregnancy progressed to term with no further prolapse. She was readmitted at 38weeks 5days of gestation with spontaneous labor. She delivered a 3.36kg male with an Apgar score at 1 minute and at 5 minutes of 7 and 8 respectively. The patient's cervix remained prolapsed in the early postpartum period; however it was easily reduced prior to discharge. After puerperium, the patient's cervix remained prolapsed. She was fitted with a vaginal pessary for uterine support. We reported this case with related literature.