Transforming Growth Factor-beta is a Possible Paracrine Mediator in the Human Endometrial Decidualization / 대한불임학회지

OBJECTIVES: To investigate the role of TGF (Transforming growth factor-beta) involved in the paracrinic communication during decidualization between UEC (uterine epithelial cells) and USC (uterine stromal cells), we have employed a co-culture system composed of human endometrial epithelial and stromal cells in defined hormonal conditions. DESiGN: in the co-culture, endometrial epithelial cells cultured in the matrigel-coated cell culture insert are seeded on top of the endometrial stromal cells cultured within a collagen gel. The co-culture was maintained for 48 hours under the following hormonal conditions: progesterone dominant condition (100 nM P4 and 1 nM E2) or estrogen-dominant condition (100 nM E2 and 1 nM P4). 10 ng/ ml HGF and/or 10 ng/ml TGF-beta1 are added. METHODS: RT-PCR is utilized to detect mRNAs quantitatively. Enzyme-linked immunosorbent assay (ELiSA) and immunohistochemical staining are utilized to detect proteins in the tissue. RESULTS: Prolactin mRNA is expressed in the co-cultured stromal cells under the progesterone dominant condition. TGF-beta1 and its receptors are expressed in both the co-cultured epithelial and stromal cells irrespective of the steroid present, which is in contrast with no or negligible expression of TGF-beta1 or its receptor in cells separately cultured. Both estrogen and progesterone significantly elevate the concentration of hepatocyte growth factor (HGF) in the conditioned medium of the co-culture with the value of 4,325 pg/ml in E2-dominant and 2,000 pg/ml in P4-dominant condition compare to 150 pg/ ml in no hormone. in separately cultured stromal cells, administration of HGF induces the expression of TGF receptor 1 in both hormonal conditions, but induction of TGF receptor 2 is only manifest in the P4-dominant condition. Administration of TGF-beta and HGF directly induce the decidualization marker prolactin mRNA in separately cultured stromal cells. CONCLUSION: it is likely that steroid hormones induces prolactin mRNA indirectly by promoting the cell to cell communication between the stromal and the epithelial cells. TGF-beta and HGF are two possible paracrine mediators in the human endometrial decidualization.

Outcome of Twin Pregnancies after Selective Fetal Reduction / 대한불임학회지

OBJECTIVES: To evaluate the safety and efficacy of selective fetal reduction (SFR) and compare the outcome of twin pregnancy after SFR in multiple pregnancy induced by assisted reproductive technology (ART) with that of natural twin pregnancy. METHODS: From September 1995 to March 2002 in Ajou University Hospital, SFR was performed in 79 patients whose gestational sacs were more than 3. Of these 79 patients, 47 patents resulted in twin pregnancy after SFR. SFR was performed using transvaginal intracardiac KCl injection at gestational age of 6~9 weeks. Control group was composed of 264 patients with natural twin pregnancy, who delivered after intrauterine pregnancy at 24 weeks, from June 1994 through December 2002. We compared Obstetric and perinatal outcomes between SFR group and natural twin group. RESULTS: Among 47 patients with twin pregnancy after SFR, 2 spontaneous abortion were occurred at intrauterine pregnancy at 8 and 19 weeks. Obstetrical and perinatal outcomes were available in 43 patients. Single intrauterine fetal death was occurred in 1 of 43 (2.3%) patients in SFR group. incidence of preterm labor, premature rupture of membrane, preeclampsia and placenta previa were similar, but gestational diabetes mellitus (GDM) was occurred more frequently in SFR group (3 (7.0%) vs 4 (1.5%), p=0.02). Mean gestational age, mean birth weight, incidence of discordancy, use of intubation and ventilation, incidence of fetal anomaly, low (<7) Apgar score and intrauterine growth restriction were similar in both groups. CONCLUSION: Twin pregnancy after SFR has the increased incidence for GDM but other obstetric and perinatal outcome was similar compared with natural twin pregnancy. So SFR is a safe and effective procedure, so we suggest SFR is needed in multifetal pregnancy more than triplet.

The Clinical Study of Laparoscopic Surgery / 대한산부인과학회잡지

OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of laparoscopy in gynecologic diseases. MATERIALS AND METHODS: A retrospective case series which includes 1711 patients who underwent laparoscopic surgery at Department of Obstetrics and Gynecology, Ajou University Hospital from June, 1994 to August, 2001 for gynecologic diseases. RESULTS: The patient's ages ranged from 11 to 77 years, and their mean age was 31.5 years. The indications of laparoscopy were ectopic pregnancy in 626 cases (36.6%), endometriosis, ovarian tumor, secondary infertility, tubal obstruction, primary infertility, myoma of the uterus, pelvic adhesion, and pelvic inflammatory disease in order. The operations performed were salpingectomy in 589 cases (34.4%), diagnostic laparoscopy, ovarian cystectomy, fulguration, salpingo-oophorectomy, laparoscopic-assisted vaginal hysterectomy, fimbrioplaty, oophorectomy, and myomectomy in order. Operation times were from 5 to 260 minutes (mean: 60.6 minutes). Postoperative hospital stays were from 0 day to 29 days (mean: 2.3 days). There were 18 surgical complications including 1 trocar site hematoma, 3 incision site infections, 9 postoperative fever, 2 postopertive ileus and 3 patinets underwnet expolatory laparotomy because of severe adhesion. CONCLUSION: We conclude that operative laparoscopy is useful in gynecologic diseases but need development of laparoscopic equipments, research of operative method, extension of operative indications, and skilled laparoscopic surgeons.

The Clinical Study of Laparoscopic Surgery / 대한산부인과학회잡지

OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of laparoscopy in gynecologic diseases. MATERIALS AND METHODS: A retrospective case series which includes 1711 patients who underwent laparoscopic surgery at Department of Obstetrics and Gynecology, Ajou University Hospital from June, 1994 to August, 2001 for gynecologic diseases. RESULTS: The patient's ages ranged from 11 to 77 years, and their mean age was 31.5 years. The indications of laparoscopy were ectopic pregnancy in 626 cases (36.6%), endometriosis, ovarian tumor, secondary infertility, tubal obstruction, primary infertility, myoma of the uterus, pelvic adhesion, and pelvic inflammatory disease in order. The operations performed were salpingectomy in 589 cases (34.4%), diagnostic laparoscopy, ovarian cystectomy, fulguration, salpingo-oophorectomy, laparoscopic-assisted vaginal hysterectomy, fimbrioplaty, oophorectomy, and myomectomy in order. Operation times were from 5 to 260 minutes (mean: 60.6 minutes). Postoperative hospital stays were from 0 day to 29 days (mean: 2.3 days). There were 18 surgical complications including 1 trocar site hematoma, 3 incision site infections, 9 postoperative fever, 2 postopertive ileus and 3 patinets underwnet expolatory laparotomy because of severe adhesion. CONCLUSION: We conclude that operative laparoscopy is useful in gynecologic diseases but need development of laparoscopic equipments, research of operative method, extension of operative indications, and skilled laparoscopic surgeons.

HCG attenuates ATP induced apoptosis in cultured human luteinized granulosa cells (hLGCs) / 대한산부인과학회잡지

OBJECTIVE: To determine the effects of hCG on extracellular ATP induced apoptosis in cultured human luteinized granulosa cells (hLGCs) METHODS: The addition of various concentrations of ATP (0, 0.1, 0.25, 0.5, 0.75 mM) and 5 IU hCG to luteinized granulosa cells obtained during in vitro fertilization ovum pickup procedures. After culture for 24 hours, purinoceptor activity and functional changes in mitochondria were measured by patch clamp, flow cytometry, and confocal microscopy. RESULTS: Calcium imaging with fura-2 revealed that ATP elevated [Ca2+]i by mobilizing intracellularly stored Ca2+. A patch clamp study showed that ATP exerted its effect by initially binding to the P2Y type purinoceptor, as evidenced by the ATP-evoked outward Ca2+-activated K+ current. Probing mitochondria with JC-1, a mitochondrial transmembrane potential-sensitive dye, revealed that ATP induced mitochondrial depolarization in a concentration-dependent manner. A quantitative flow cytometric analysis with Annexin V showed that apoptotic cells were increased in number in proportion to the concentration of ATP, having 18.57% of apoptotic cell populations in the presence of 0.75 mM ATP compared to 7.88% in the control. Moreover, treatments with human chorionic gonadotropin (hCG) at 5 IU reversed both the ATP-induced mitochondrial depolarization and apoptosis (18.57 vs 6.32%). CONCLUSION: Taken together, these results indicate, first, extracellular ATP recognized by the P2Y type purinoceptor on h-LGCs increases the intracellular Ca2+. Second, the increased intracellular Ca2+ triggers the apoptotic cascade by acting at least, in part, on mitochondria. Third, hCG reverses the ATP-induced apoptosis, raising a possible clinical implication of hCG in the treatment of degeneration of granulosa cells such as follicular atresia.

The Significance of Normal 100 gm Oral Glucose Tolerance Test on Perinatal Outcomes / 대한산부인과학회잡지

OBJECTIVE: To evaluate perinatal outcomes in patients with abnormal 50 gm challenge test followed by normal 100 gm oral glucose tolerance test (OGTT) value. METHODS: We examined the pregnancy outcomes of 423 women classified as the study group with abnormal 50 gm oral glucose challenge test (OGCT) followed by normal 100 gm OGTT based on NDDG criteria. If the 1-hour plasma glucose value of 50 gm OGCT was over 130 mg/dL, the patient was scheduled for a full 3-hour 100 gm OGTT. 50 gm OGCT and 100 gm OGTT were administered at 24-28 and 28-32 weeks' gestation, respectively. The control group constituted of 467 age- and body mass index (BMI)-matched negative screenees. We defined poor maternal outcomes as those suffering from any one of hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, or fetal distress. We also defined poor neonatal outcomes as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome, or perinatal mortality. Retrospective review of outcomes of these patients was performed. Student t-test, Fisher's exact test and chi-square test were used to determine the statistical significance. RESULTS: There were no significant differences in demographic and obstetric characteristics between the control group and the study group. There were no significant differences in gestational age (38.7+/-1.5 vs 38.5+/-1.5 weeks), birth weight (3189.2+/-420.9 vs 3236.7+/-423.1 gm), between the groups. And there were no significant differences in preterm birth (6.2% vs 7.4%), large for gestational age births (4.5% vs 5.0%), intrauterine growth restriction (5.4% vs 4.3%) between the groups. There were no significant differences in poor maternal outcomes (15.6% vs 18.7%) and poor neonatal outcomes (3.9% vs 5.7%) between the groups. CONCLUSION: We conclude that abnormal value on 50 gm challenge test followed by normal 100 gm OGTT is not associated with adverse perinatal outcomes.

Laparoscopic management of ovarian pathologic lesions / 대한산부인과학회잡지

OBJECTIVE: To assess the advantages, disadvantages, applicability, and complications of operative laparoscopy in ovarian pathologic lesions. MATERIALS AND METHODS: A retrospective case series which compares 354 patients who had laparoscopic surgery at Ajou University Hospital from June, 1994 to September, 2001 for ovarian pathology. RESULTS: The patient's ages ranged from 13 to 77 years, and their mean age was 30.9 years. Most of the lesions were less than 7 cm in size and unilateral. The operations performed were cystectomy in 225 cases (63.6%), salpingooophorectomy, oophorectomy, salpingectomy and fenestration or biopsy in order. Operative times were between 10 and 240 minutes (mean: 74.2 minutes). Pathologic examinations of unilateral ovarian tumors were performed in 305 cases. The most common pathology of unilateral ovarian tumor was teratoma (107/305, 35.1%), endometrioma and cystadenoma in order. Malignancies were found in 4 cases including borderline malignancy (1.3%). Pathologies of bilateral ovarian tumor were endometrioma (31/41, 75.6%), teratoma, and fibroma in order. Postoperative hospital stays were from 0 days to 19 days (mean: 2.5 days). There were 7 surgical complications including 3 vessel injury related hematomas, 1 abscess formation, and 3 exploratory laparotomy. CONCLUSIONS: We concluded that operative laparoscopy was useful in surgery of ovarian lesions, if there are carefully selected patients, standard procedures, and skilled laparoscopic surgeons.

The Efficacy of Sclerotherapy for Conservative Treatment of Ovarian Pseudocyst / 대한불임학회지

OBJECTIVE: To evaluate the efficacy of sclerotherapy for conservative treatment of ovarian pseudocyst. METHODS: Patients with ovarian pseudocyst who had undergone sclerotherapy at Ajou University Hospital from February, 1997 to March, 2002 were included in this study. Sclerotherapy was performed as follows: Under intravenous analgesia, the cyst was irrigated with dehydrated alcohol after aspiration under transvaginal sonography. The aspirated contents and alcohol irrigated contents were sent for cytologic examination. RESULTS: 71 patients with ovarian pseudocyst were performed sclerotherapy. All but 2 patients were followed up for 0.5 to 33 months with transvaginal sonography and pelvic examination. Mean age of the patients was 40 years old. Mean size of the pseudocyst was 8.0 cm, mean amount of aspiration fluid was 179.8 ml, and average follow-up duration was 6.0 months. All had abdominal or pelvic surgical history and 38 patients (58.9%) of them had undergone hysterectomy. 44 of 71 patients (62.0%) were performed sclerotherapy only one time. 27 patients (38.0%) recurred and were undergone more than one time. Complication was not occurred in all cases. CONSLUSIONS: We concluded that although pseudocyst after sclerotherapy has high recurrence rate, sclerotherapy was an safe and effective method for conservative treatment of ovarian pseudocyst.

The Efficacy of Sclerotherapy for Conservative Treatment of Ovarian Pseudocyst / 대한불임학회지

OBJECTIVE: To evaluate the efficacy of sclerotherapy for conservative treatment of ovarian pseudocyst. METHODS: Patients with ovarian pseudocyst who had undergone sclerotherapy at Ajou University Hospital from February, 1997 to March, 2002 were included in this study. Sclerotherapy was performed as follows: Under intravenous analgesia, the cyst was irrigated with dehydrated alcohol after aspiration under transvaginal sonography. The aspirated contents and alcohol irrigated contents were sent for cytologic examination. RESULTS: 71 patients with ovarian pseudocyst were performed sclerotherapy. All but 2 patients were followed up for 0.5 to 33 months with transvaginal sonography and pelvic examination. Mean age of the patients was 40 years old. Mean size of the pseudocyst was 8.0 cm, mean amount of aspiration fluid was 179.8 ml, and average follow-up duration was 6.0 months. All had abdominal or pelvic surgical history and 38 patients (58.9%) of them had undergone hysterectomy. 44 of 71 patients (62.0%) were performed sclerotherapy only one time. 27 patients (38.0%) recurred and were undergone more than one time. Complication was not occurred in all cases. CONSLUSIONS: We concluded that although pseudocyst after sclerotherapy has high recurrence rate, sclerotherapy was an safe and effective method for conservative treatment of ovarian pseudocyst.

Effects of Different Infusion Frequency of Liquid Nitrogen on Human Embryo Development and Pregnancy Rates after Freezing and Thawing / 대한불임학회지

OBJETIVE: To investigate the efficacy of high infusion frequency of liquid nitrogen on pregnancy in human embryo after freezing and thawing. MATERIALS AND METHODS:: 150 infertile patients underwent 162 consecutive thawing-ET cycles. In the high infusion frequency group (Group A), 47 patients (50 cycles) underwent cryopreservation with high infusion frequency of liquid nitrogen. In the low infusion frequency group (Group B), 103 patients (112 cycles) underwent cryopreservation with low infusion frequency of liquid nitrogen. We analyzed the clinical characteristics, fertilization rates, development of embryo, good quality embryo ratio, implantation rates, and pregnancy rates between these two groups. RESULTS: There was no difference between the groups with regard to clinical characteristics (mean age, infertility duration, infertility factors, hormone profile), mean number of oocyte retrieval, fertilization rates, and mean embryo number of transfers. The survival rates in group A was 64.9% (228 of 350 embryos), and among the 228 embryos 190 embryos (83.3%) which progressed to the two- to eight-cell stage. After thawing, the embryo numbers were 65 (34.2%), 29 (15.3%), 35 (18.4%), and 37 (19.5%) of grades 1, 2, 3, and above 4, respectively. The survival rates in group B was 63.8% (482 of 755 embryos), and among the 482 embryos 465 embryos (96.5%) which progressed to the two- to eight-cell stage. After thawing, the embryo numbers were 106 (22.8%), 94 (20.2%), 89 (19.1%), and 112 (24.1%) of grades 1, 2, 3, and above 4, respectively. There was no difference in embryo quality change after the freezing-thawing procedure between the groups. Implantation rates (31.1% vs. 34.3%) were not significant. However hCG positive rates in group A (40%) were higher than group B, but not statistically significant. Clinical pregnancy rate (26% vs. 25.9%), on going pregnancy rates (>20 weeks) were not significant (26% vs. 25%). CONCLUSION: We compared embryo quality change, survival rates, and pregnancy rates between high infusion frequency group and low infusion frequency group and the results were similar between the two groups. Therefore, high infusion frequency of liquid nitrogen for cryopreservation is a worthy method to preserve in human embryos.

The Clinical Significance of The Qualification of Atypical Squamous Cells of Undetermined Significance (ASCUS) in Cervicovaginal Smears / 대한산부인과학회잡지

OBJECTIVE: The Bethesda System (1991) recommended that the diagnosis of atypical squamous cells of undetermined significance (ASCUS) be qualified when possible to indicate whether a reactive process, or premalignant/malignant process, is favored. In order to evaluate the clinical significance of the qualification, we reviewed our hospital's experience with cervicovaginal smears diagnosed as ASCUS. METHOD: A retrospective study from June 1994 to December 2000 was performed on all cervicovaginal smears with the diagnosis of ASCUS. 3759 cases were included in study group. The 1200 cases of 3759 were not followed up. Histopathologic diagnosis and cervicovaginal smear results were reviewed and compared according to the qualification of ASCUS. The Chi-square test was used. RESULTS: Histopathologic diagnosis of low-grade squamous intraepithelial lesion (LGSIL) was seen in 46.1%, 47.8%, and 44.3% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. Histopathologic diagnosis of high-grade squamous intraepithelial lesion (HGSIL) was seen in 6.0%, 17.2% and 7.8% of the ASCUS FR, ASCUS FD and ASCUS NOS group, respectively. In ASCUS FR group, 1 invasive carcinoma was detected. In ASCUS FD group, 6 carcinoma in situ (CIS), 2 microinvasive carcinoma, 1 invasive carcinoma and 1 adenosquamous cell carcinoma were detected. In ASCUS NOS group, there were 20 CIS, 5 microinvasive carcinoma, 7 invasive carcinoma and 2 invasive adenocarcinoma. The ASCUS FD group demonstrated significant risk for SIL and more severe lesion but ASCUS FR and ASCUS NOS demonstrated no significant difference. CONCLUSION: ASCUS FD group has increased risk for detection of SIL or more severe lesion than ASCUS FR or ASCUS NOS group. But there were also significant number of SIL and even invasive cancer in ASCUS FR and ASCUS NOS group, so qualification of ASCUS was not useful for management and colposcopy-directed biopsy is advocated even in ASCUS FR group.

A case of Colorectal carcinoma During Pregnancy / 대한산부인과학회잡지

Colorectal cancer during pregnancy is rare but the trend for women to delay pregnancy until later in life may result in increased incidence of colorectal cancer during pregnancy. The most common symptoms are rectal bleeding, abdominal discomfort, abdominal distension, anorexia, nausea, vomiting, constipation, anemia and weight loss. Rectal bleeding, if it is occurred, is often attributed to hemorrhoids, a common finding of pregnancy and many of these symptoms are commonplace in normal pregnancy. This delays diagnosis of colorectal cancer during pregnancy and leads to more advanced stage and poor prognosis compared to the general population. We experienced a woman at 27 weeks gestation who complained of low abdominal distention and was diagnosed of sigmoid colon cancer and underwent cesarean section and hemicolectomy at 30 weeks gestation, so we present it with brief review of literature."