Retroperitoneal vascular anomalies in paraaortic region: Impact on laparoscopic paraaortic lymphadenectomy in patients with gynecologic malignancies / 대한산부인과내시경학회지

OBJECTIVE: To document our experience of the vascular anomalies or variants in paraaortic region and intend to increase vigilance among the gynecological surgeons for presence of variable vascular anomalies or variants. METHODS: We conducted a retrospective chart review of 280 patients with various gynecologic malignancies who had undergone systemic laparotomic or laparoscopic paraaortic lymphadenectomy between November 2003 and July 2011. RESULTS: We discovered total nine patients of vascular anomalies during the surgery. Seven patients had an accessory polar renal artery. One patient had a duplicated inferior vena cava and the other had a right paravertebral vein. There were no vascular complications such as tearing, ligation or transection. CONCLUSION: It is not uncommon to encounter vascular anomalies in paraaortic region during the lymphadenectomy. Hence, the gynecological surgeons must be cognizant of various vascular anomalies occurring within this area to reduce the vascular accidents.

Serum bisphenol-A concentrations from uterine leiomyoma patients / 대한산부인과학회지

OBJECTIVE: To investigate how many leiomyoma patients are exposed to bisphenol-A (BPA) and whether the serum concentration of BPA is related to leiomyoma growth. METHODS: Total 131 patients were recruited for measuring BPA. Initially, leiomyoma patients were divided into three groups, mild (n=38), moderate (n=33), and severe (n=30) according to the size of the leiomyomas. The control (n=30) group was defined as having no leiomyomas. The identification and diameter measurements of leiomyomas was performed by transvaginal ultrasonography. Serum BPA concentrations were measured by enzyme linked immunosorbent assay. RESULTS: BPA was detected in 83.9% out of 131 samples totally, and 83.1% out of 101 leiomyoma patients. In detail, the detection rates of serum BPA were 86.7% in control group, 71.1% in mild group, 84.9% in moderate group, and 96.7% in severe group. The mean BPA concentrations in the control group was 0.557+/-0.086 ng/mL and those in the leiomyoma groups were 0.273+/-0.052 ng/mL (mild), 0.336+/-0.063 ng/mL (moderate), and 0.636+/-0.075 ng/mL (severe) (P=0.0003). Values are mean+/-standard error. Conclusions: The detection rate of serum BPA in control and leiomyoma groups were 86.7% and 83.1% respectively. However, there was no statistical significance of serum BPA concentrations between control and leiomyoma groups. To verify the effect of BPA on the leiomyoma growth, close and sequential monitoring for the person who have exposure risk is recommended.

A case of successfully resected retroperitoneal hemangiopericytoma / 대한산부인과학회지

Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumor. Hemangiopericytoma is known to be derived from the vascular pericyte and occurs most commonly lower extremities, pelvis and retroperitoneum. Surgical radical excision is the treatment of choice. Because of malignant features of hemangiopericytoma, long term and close follow-up is important. We report a case of successfully resected retroperitoneal hemangiopericytoma.

Declining concentrations of dehydroepiandrosterone sulfate and free testosterone with advancing age / 대한산부인과학회지

OBJECTIVE: To investigate the relationship between serum dehydroepiandrosterone sulfate (DHEAS) or free testosterone (FT) levels and aging. METHODS:One hundred and thirty one women without androgen excess symptoms such as oligomenorrhea or amenorrhea or hirsutism were recruited for measuring serum DHEAS, FT levels by radioimmunoassay. A P-value <0.05 was considered to be significant statistically. RESULTS: The levels of DHEAS were 211.39+/-33.01 microg/dL (twenties, n=10), 127.99+/-11.79 microg/dL (thirties, n=31), 94.30+/-7.49 microg/dL (forties, n=57) and 71.79+/-5.71 microg/dL (over fifties, n=33) respectively (mean+/-SE, P<0.001). The levels of FT were 3.98+/-0.94 pg/ml (twenties, n=10), 3.37+/-0.47 pg/mL (thirties, n=31), 2.68+/-0.30 pg/mL (forties, n=57) and 1.97+/-0.28 pg/mL (fifties, n=33) respectively (mean+/-SE, P=0.030). Mean value declining of DHEAS (r=-0.48865, P<0.0001) was bigger than those of FT (r=-0.29334, P<0.0007). CONCLUSION: Both DHEAS and FT levels decline with age and DHEAS decreases more steeply than FT.

Declining concentrations of dehydroepiandrosterone sulfate and free testosterone with advancing age / 대한산부인과학회지

OBJECTIVE: To investigate the relationship between serum dehydroepiandrosterone sulfate (DHEAS) or free testosterone (FT) levels and aging. METHODS:One hundred and thirty one women without androgen excess symptoms such as oligomenorrhea or amenorrhea or hirsutism were recruited for measuring serum DHEAS, FT levels by radioimmunoassay. A P-value <0.05 was considered to be significant statistically. RESULTS: The levels of DHEAS were 211.39+/-33.01 microg/dL (twenties, n=10), 127.99+/-11.79 microg/dL (thirties, n=31), 94.30+/-7.49 microg/dL (forties, n=57) and 71.79+/-5.71 microg/dL (over fifties, n=33) respectively (mean+/-SE, P<0.001). The levels of FT were 3.98+/-0.94 pg/ml (twenties, n=10), 3.37+/-0.47 pg/mL (thirties, n=31), 2.68+/-0.30 pg/mL (forties, n=57) and 1.97+/-0.28 pg/mL (fifties, n=33) respectively (mean+/-SE, P=0.030). Mean value declining of DHEAS (r=-0.48865, P<0.0001) was bigger than those of FT (r=-0.29334, P<0.0007). CONCLUSION: Both DHEAS and FT levels decline with age and DHEAS decreases more steeply than FT.

Mercury Concentrations of Maternal and Umbilical Cord Blood in Korean Pregnant Women: Preliminary Study / 대한산업의학회지

OBJECTIVES: To evaluate the level of maternal and prenatal mercury exposure and to analyze the related factors. METHODS: Fifty-nine pregnant women were recruited into this study after obtaining informed consent. Samples were collected at delivery from normal pregnant women who were living in the city of Busan, Korea. Mercury concentrations in maternal and umbilical cord blood samples were measured using a gold-amalgam collection method. The total and methyl mercury levels of 36 of the 59 pregnant women were analyzed after randomization, and the results were compared. RESULTS: The mean total mercury concentration was 3.16+/-1.21 ppb and 5.43+/-2.22 ppb in maternal and cord blood, respectively. The average, maternal blood mercury level was lower than the prescribed toxic limit for human (WHO, 5 ppb), whereas the cord blood mercury was higher. The mercury exposure level exceeded the WHO recommendation in 5 (8.47%) cases of maternal blood and 29 of (49.15%) cord blood. There was a significant correlation between maternal and cord blood mercury concentrations. Total mercury and methyl mercury concentrations of the 36 random pregnant women were 3.06+/-1.17 ppb, and 2.60+/-1.11 ppb in maternal blood, and 5.20+/-2.36 ppb, and 4.70+/-1.97 ppb in cord blood, respectively. Methyl mercury accounted for 85.0% of the total mercury in maternal blood and 90.4% in cord blood. There was a significant correlation between total and methyl mercury concentrations. CONCLUSIONS: The study results suggest that mercury concentrations of cord blood may be regarded as indicative of high prenatal mercury exposure. Therefore, further studies are necessary to explain the cause of high mercury concentrations in cord blood, and to examine its relationship with various health indices.

+764 G/A Mutation of Inhibin-alpha Gene in Korean Patients with Idiopathic Premature Ovarian Failure / 대한산부인과학회지

OBJECTIVE: To evaluate the incidence of the +769 G/A mutation of inhibin-alpha gene in Korean patients with idiopathic premature ovarian failure. DESIGN: DNA analysis of the mutation. METHODS: One hundred patients with idiopathic premature ovarian failure (POF) were recruited. Patient with known causes of premature ovarian failure were excluded: cytogenetic abnormalities, prior chemotherapy, prior bilateral oophorectomy and autoimmune disease, etc. DNA was extracted from peripheral blood and the +769 G/A variant of Inhibin-alpha gene (INH-alpha) was analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism using restriction enzyme BbvI. RESULTS: We didn't find any case of +769 G/A variant in Inhibin-alpha gene in 100 Korean patients with idiopathic POF. CONCLUSION: This result suggests that in contrary to the recent data reported on the Asian population, the +769 G/A variant in inhibin-alpha gene may not exist in Korean patients with idiopathic POF.

The Clinical Study of Abdominopelvic Actinomycosis

PURPOSE: Abdominal actinomycosis is a rare chronic suppurative infectious disease, caused by a gram-positive bands Actinomyces israelii organism. The pathogens produces a characteristic granulomatous inflammatory fibrosis and mass lesion. Actinomycosis is usually divided into three clinical types; cervicofascial, thoracic and abdominopelvic. This study was designed to investigate the clinical or radiologic variability and the meanings of the diagnostic differentiality of abdominopelvic actinomycosis when patients present with an unusual abdominal mass or abscess. METHODS: The medical records of 19 patients treated at the Departments of Surgery and Obstetrics and Gynecology, Dong-A University Hospital were reviewed. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: Of the 19 patients, 7 cases involved the colon and 11 the uterus and ovary with one case also involving the retroperoneum and ureter. Most cases (84.2%) had predisposing factors of disease progression, including intrauterine device (IUD), abortion, previous surgery, appendicitis and diverticulitis. The common presentations of the patients were abdominal pain (57.8%) and a palpable mass (15.7%). Preoperatively, no case was diagnosed as actinomycosis, but misconceived as a pelvic abscess, ovarian or colon cancers, a mesenteric origin mass, a lymphoma, periappendiceal abscess, acute appendicitis, uterine myoma, dysfunctional uterine bleeding or endometriosis. Explorations were performed in all patients. Eighteen cases were cured following surgery with subsequent antibiotics. However, one case recurred due to incompletion of antibiotics following surgical drainage. CONCLUSION: Abdominopelvic actinomycosis should be included as a differential diagnosis when an unusual abdominal mass presents on abdominal CT or ultrasound. Appropriate antibiotics, as well as surgery, are important in the treatment of abdominopelvic actinomycosis.

A Case of Uterine Adenofibroma / 대한산부인과학회지

Uterine adenofibroma is an extremely rare benign biphasic neoplasm that is classified into mixed m?llerian tumor. This mass lesion appears to be clinical and histologically benign but it should be differentiated from other malignant neoplasms of uterus. We have experienced a case of uterine adenofibroma in a 53-year-old woman and report this case with a brief review of literature.

A case of primary vaginal leiomyosarcoma metastasized to the lung / 대한산부인과학회지

Primary malignant lesions of the vagina represent less than 2% of all gynecologic malignancies. Primary vaginal sarcoma accounts for about 2% of all malignant vaginal lesions and the leiomyosarcoma is the most common vaginal sarcoma found in adult women. The treatment is wide resection of lesion and radiotherapy or chemotherapy, but the progress is not hopeful. We report a case of primary vaginal sarcoma metastasized to the lung. Although the primary lesion was 1.8 cm, but the patient died of metastatic lung cancer.

Effect of Antenatal Corticosteroid and Antibiotics in Pregnancies Complicated by Premature Rupture of Membranes between 24 and 28 weeks of Gestation

The aim of this study was to assess the effectiveness of active intervention with antenatal maternal corticosteroid and antibiotics therapy in infants delivered between 24 and 28 weeks of gestation after premature rupture of membrane. This retrospective study included pregnant women complicated by preterm delivery at the Dong-A University Hospital from 1998 to 2002. Patients were divided into labor induction group 1 (n=20), observation group 2 (n=19), and medication group 3 (n=20). We evaluated the effects of prolongation of pregnancy and intervention with maternal corticosteroids and antibiotics therapy on perinatal and neonatal outcomes. Each group did not have a significant difference (p<0.05) in neonatal outcomes, such as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, pneumonia, bronchopulmonary dysplasia, and sepsis. The mean latency period was 4.7 days and 7.6 days in groups 2 and 3, respectively. Therefore, this study was unable to demonstrate any beneficial effects of corticosteroids in improving neonatal outcomes and prolongation of the latency period with antibiotics.

A Case of Premature Ovarian Failure in Patient with Unbalanced translocation on the X chromosome / 대한산부인과학회지

Premature ovarian failure (POF) is defined as the complete cessation of menses less than 40 years of age. The criteria are more than four months of amenorrhea, with serum follicle stimulating hormone value of >40 mIU/mL and the frequency of POF is about 1% of all women. Although the etiologies of POF remain unknown, suggested factors are genetic, autoimmune, chemotherapy and environmental toxicants. The cytogenetic abnormalities predominantly concern the X chromosome, including Turner syndrome, Fragile X syndrome and deletion or translocation of X chromosome. We report a case of premature ovarian failure with the following karyotype: 46,X,der(X), t(X;11)(q28;p13).

Analysis of prognostic factor and survival in patients with epithelial ovarian cancer treated with combination chemotherapy / 부인종양

OBJECTIVE: The purpose of this retrospective study is to identify and to discuss the clinical relevance of prognostic factors and survival rate in patients with epithelial ovarian cancer treated with combination chemotherapy. METHODS: A total of 98 histologically verified patients with epithelial ovarian cancer who were treated at Dong-A Medical Center between 1997 and 2002 were used for analysis. The 30 patients having borderline tumor were excluded. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. A multivariable Cox proportional hazard model was applied to access the prognostic significance of the different covariates. RESULTS: The median age of the patients with epithelial ovarian cancer was 46.6 years and FIGO stage distribution was 38.2% for stage I, 5.9% for stage II, 44.1% for stage III, 11.8% for stage IV. The histopathologic type distribution were serous type (45.6%), mucinous type (36.8%), endometriod type (8.8%), clear cell type (7.4%), mixed type (1.4%). Residual tumor volume size of less than 1 cm or 1 cm was identified in 50 patients (73.5%) and more than 1 cm in 18 patients (26.5%) after primary cytoreductive surgery. The overall 5-year survival rate was 55.7%. According to univariate analysis, FIGO stage (p<0.0001), residual volume (p<0.0001), ascitic fluid volume (p=0.0001), menopause (p=0.0021), CA125 (p=0.0058), tumor size (p=0.0099), age (p=0.0113) were significant prognostic factors affecting survival. However, multivariate analysis in this study demonstrated that FIGO stage (p=0.011), residual tumor volume (p=0.026), ascitic fluid volume (p=0.031) were found to be the most significant independent prognostic factors. CONCLUSION: In this retrospective study, the overall 5-year survival rate of patients with epithelial ovarian cancer treated with combination chemotherapy was 55.7% and 5-year survival rate of stage I/II was 95.8%, stage III 28.4%, stage IV 0%. The overall survival of stage I/II were 90 months, stage III 39 months, stage IV 17 months. In multiple analysis, FIGO stage, residual volume, ascitic fluid volume were identified as three most significant independent prognostic factors.

The Histologic Features of the Uterus and Adnexa Extirpated from Gender Identity Disorder Patients with Depot Androgen Injection / 대한불임학회지

OBJECTIVE: To investigate the histologic features of the uterus and adnexae extirpated from gender identity disorder (GID) patients that received depot androgen injection. METHODS: We reviewed the histologic findings of the uterus and adnexae removed from sixteen GID patients, who had taken depot androgen injection for 5~168 months. RESULTS: Fourteen patients (87.5%) showed the atrophied epithelium of exocervix and all of 16 patients (100%) showed the atrophy of endometrium. Seven patients (43.7%) showed multiple cystic follicles in the ovarian cortex and 6 patients (37.5%), 3 patients (18.7%) showed corpus albicans and corpus luteum, respectively. CONCLUSIONS: Exogenous androgen induced atrophy of cervix and endometrium. This effect was more prominent in the endometrium. In addition, PCO-like histologic features were observed in the ovary.

The Pathogenesis of Adenomyosis Through the Immunohistochemical Study with bcl-2 and MMP-9 / 대한산부인과학회잡지

OBJECTIVE: To understand the pathogenesis of adenomyosis through the immunohistochemical staining with bcl-2 and matrix metalloproteinase-9 (MMP-9) antibody. METHODS: We selected 45 cases of adenomyosis among the uterine specimens that were extirpated surgically due to benign gynecologic problem. Immunohistochemical staining to the myometrial tissue was performed using anti-bcl-2 and anti-MMP-9 antibodies. Staining was qualitatively assessed in terms of extent and intensity. RESULTS: There were 32 cases of proliferative phase and 13 cases of secretory phase depending on the date of endometrium. Anti-bcl-2 stained 81.3% (26/32) compared with anti-MMP-9 stained 6.3% (2/32) in the glandular tissue of the proliferative phase (p<.001). In the secretory phase, anti-bcl-2 92.3% (12/13) and anti- MMP-9 7.7% (1/13) respectively (p<.001). In the stromal tissue of the proliferative phase, anti-bcl-2 stained 62.5% (20/32) compared with anti- MMP-9 stained 6.3% (2/32) (p<.001). In the secetory phase, anti-bcl-2 84.6% (11/13) and anti-MMP-9 15.4% (2/13) (p<.001). CONCLUSION: The adenomyosis may be developed from simple invagination and cellular proliferation of endometrial tissue, not caused by myometrial infiltration of endometrial tissue.

Prenatal Diagnosis of Recurrent Trisomy 18 Syndrome / 대한진단검사의학회지

Though data on the recurrent risk after the birth of one fetus or infant with trisomy 18 is sparse, it has been presumed that the recurrence risk would be lower than the 1% for full trisomy 21 syndrome cases. We report a rare recurrent trisomy 18 found in amniocentesis in a family in which both parents had normal blood karyotype. Molecular analysis was undertaken in the second episode of trisomy 18 and a maternal meiosis II nondisjunction error was diagnosed.

A Case of Cushing's Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma

Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing's syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing's syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.

A Case of Spontaneously Regressed Hyperreactio Luteinalis Occurred in Normal Pregnancy / 대한산부인과학회잡지

Hyperreactio luteinalis rarely occurs in normal single pregnancy. About 50 such cases have been published. It is usually occurs in trophoblastic disease. This case is a huge hyperreactio luteinalis that detected in gestational age 16 weeks. The patient delivered a normal female infant at 41th week of gestation without any mass related problems. The hyperreactio luteinalis was a benign condition in itself with normal spontaneous remission in two months after delivery. Also the level of elevated human chorionic gonadotropin became normal. The conservative management was appropriated. This case is noteworthy because it resulted in spontaneous regression without surgical intervention and conserved ovarian tissue.

The Efficacy of Intracytoplasmic Sperm Injection for Previous Fertilization Failure with Conventional In Vitro Fertilization / 대한불임학회지

OBJECTIVE: This study is to evaluate the efficacy of Intracytoplasmic Sperm Injection(ICSI) for previous fertilization failure with conventional in vitro fertilization(IVF), compared with ICSI for male factor. METHOD: The author analyzed the 3 years of clinical experience with ICSI retrospectively, between the conventional IVF failure group (IVF failure) and male factor group (male factor). Surgically retrieved epididymal or testicular spermatozoa for ICSI were excluded. The IVF failure group was 13 cycles of 6 patients and male factor group was 30 cycles of 15 patients. RESULTS: The fertilization rates of the IVF failure group and male factor group were 63% and 66% respectively (p=0.635). The clinical pregnancy rates of the both group were 23.1% and 26.7% (p=0.804), and that of live birth rates were 15.4% and 13.3% (p=0.858). There were no significant difference between the two groups. CONCLUSION: The author concluded that ICSI can overcome previous fertilization failure, with the same fertilization and clinical pregnancy rates seen in patients with male factor.

The Clinical Efficacy of the Low-dose FSH Regimen for Intrauterine Insemination / 대한불임학회지

OBJECTIVE: This study is to investigate the clinical efficacy of low-dose FSH regimen, comparing with clomiphene citrate and human menopausal gonadotropin (CC/hMG) regimen. METHODS: Retrospective study of the ovulatory factor infertility 39 patients who had been treated by intrauterine insemination (IUI). The 31 cycles of 21 patients were stimulated by CC/hMG regimen, the 22 cycles of 18 patients were stimulated by low-dose FSH regimen. We compared the rate of clinical pregnancy, multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) of both group. RESULTS: The rate of clinical pregnancy of the CC/hMG group was 25.7% per cycle, and that of the low-dose FSH group was 54.5% per cycle. The low-dose FSH group showed a higher rate of clinical pregnancy per cycle than CC/hMG group (p=0.028). However, no differences was found statistically in the rate of multiple pregnancy and OHSS between CC/hMG group (22.2%, 5.7%) and low-dose FSH group (33.3%, 13.6%). CONCLUSION: This study showed that the low-dose FSH regimen is superior to CC/hMG regimen in getting clinical pregnancy, but dose not reduce the ovulation induction complications.