A Case of Advanced Gastric Cancer Diagnosed by Endoscopy Performed in the Second Trimester due to Persistent Nausea and Vomiting / 대한주산의학회잡지

Gastric cancer is rarely associated with pregnancy and its incidence is reported to be 0.1%. The dilemma in the treatment of this rare occasion is that it is usually diagnosed at an advanced stage. The most common reason for delayed diagnosis is that early symptoms of gastric cancer, such as nausea, vomiting and epigastric discomfort, are nonspecific and usually misinterpreted as those related to pregnancy. Clinicians' reluctance to request diagnostic studies is another reason for delayed diagnosis. So these make the prognosis much worse. We must consider the rare possibility of gastric cancer in case of persistent nausea and vomiting. We report a case of advanced gastric cancer diagnosed by gastroscopic examination performed in the second trimester because of persistent nausea and vomiting.

Cord blood-derived CD34(+) cells promotes functional recovery in transient middle cerebral artery occlusion model of rat / 대한산부인과학회지

OBJECTIVE: This study was designated to determine the effect of cord blood cell transplantation in ischemic injury model. METHODS: In this study, we administered human umbilical cord blood (hUCB)-derived CD34(+) cells into the lateral ventricle or directly into the striatum and assessed cell migration in mice with cryoinjury and behavioral recovery in rats with transient middle cerebral artery occlusion (MCAo). CD34(+) cells were isolated by magnetic cell sorting using CD34-microbeads and labeled with CM-Dil. RESULTS: When CD34(+) cells were injected into mice brain with cryoinjury, cells were migrated into a injury site after one week of injection. Similarly, injected CD34(+) cells were migrated into the periphery of infarcted area in rats with transient MCAo. When spontaneous activity was measured using a modified neurological severity score (mNSS), it was found that functional recovery was significantly higher when CD34(+) human umbilical cord blood cell (hUCBC) was transplanted 24 hours after stroke compared with phosphate buffered saline (PBS)-injected or CD34(-) transplanted, stroked animals (P<0.05). Although only small portion of transplanted cells were differentiated into neural lineages, CD34(+) hUCBC transplantation increased Brdu incorporation and recruitment of doublecortin (DCX) (+) cells in ischemic boundary zone. CONCLUSION: These results suggest that hUCBC transplantation may be an effective treatment for brain injuries, such as stroke, or neurodegenerative disorders by promoting endogenous repair process of the brain.

A case of imperforate hymen in newborn infant causing hydrometrocolpos and hydronephrosis / 대한산부인과학회지

Imperforate hymen is a common congenital malformation, but usually remains asymptomatic and not detected until menarche. Neonatal hydrometrocolpos caused by imperforate hymen is reported to be very rare. We report a case of hydrometrocolpos in newborn presenting with pelvic mass and bulging membrane in vaginal introitus causing both hydronephrosis which is treated surgically with good result.

Cytogenetic abnormalities in patients with reproductive dysfunction / 대한산부인과학회지

OBJECTIVE: The aim of this study was to investigate the relationship between chromosome abnormalities and male or female reproductive dysfunction and to be convinced of the role of pericentric inversion of chromosome 9 (inv (9)) on human phenotypes. METHODS: Between Jan. 1995 and Dec. 2003, results of 1713 chromosomal analyses which were referred to our cytogenetic laboratory were analyzed. Study groups consisted of 658 cases of men and 18 cases of women with unexplained infertility, 65 cases of men and 109 cases of women with history of recurrent spontaneous abortion, 78 cases of women with primary amenorrhea, 61 cases of women with secondary amenorrhea and, 382 cases of men and 342 cases of women with no reproductive dysfunction (control group). The incidence of inv (9) among each group was compared with control group. RESULTS: Chromosomal abnormalities were found in 110 cases (16.7%), 2 cases (11.1%), 3 cases (4.6%), 15 cases (13.8%), 29 cases (37.2%) and 10 cases (16.4%) in each group. The incidence of chromosomal abnormalities in male infertility was higher than previous reports, and 10 cases of inv (9) were detected in male infertility group. In cases of women with infertility and secondary amenorrhea, we couldn't find the relevance between reproductive dysfunction and chromosomal abnormality. In cases of women with recurrent spontaneous abortion, 6 cases (5.5%) had autosomal translocation and 7 cases (6.42%) had inv (9). In cases with primary amenorrhea, most chromosomal abnormalities found were related to sex chromosome such as Turner's syndrome, similar to other investigations. Thirty three cases of inv (9) was detected among the whole 1713 chromosomal analyses (1.93%). In cases of male infertility, 10 cases (1.52%) had inv (9), not significantly different with male control group. But 7 cases (6.42%) of inv (9) in women with recurrent spontaneous abortion were significantly higher than female control group (p<0.05). CONCLUSION: Because considerable proportion of patients with reproductive dysfunction had various cytogenetic abnormalities, the chromosomal analysis should be considered as a diagnostic tool in the evaluation of reproductive dysfunction such as infertility, recurrent spontaneous abortion, and amenorrhea. We also found that Inv (9) had a significantly increased incidence in female recurrent spontaneous abortion.

Current status and concepts of stem cell therapy / 대한산부인과학회지

In this 21st century which is considered as the era of biotechnology, the regenerative medicine emerging as an important medical science has been expected to provide hope to patients of incurable diseases, such as myriad of degenerative disease or terminal organ failure which can not be solved until recently. Because It is also thought to be a epochal alternative therapy in every medical part including cardiovascular disease, neurological disorder, hereditary disease, liver disease, endocrine disorder, bone or cartilage disease, and skin disease, many stem cell researches are conducted and many results are reported. Stem cells are at the center of this regenerative medicine. Although there is public debate because it is inevitably associated with ethical problems like destruction of embryo or risk of reproductive cloning, stem cell research generated much interest because the expected therapeutic effect and the derived economic value would be enormous. This review will describe the characteristics of stem cell and summarize the published research results recently.

Cytogenetic and Clinical Analysis in 3,537 Cases of Midtrimester Amniocentesis / 대한주산의학회잡지

OBJECTIVE: To analyze the incidence of chromosomal abnormalities according to age and indications in midtrimester amniocentesis performed for prenatal genetic diagnosis. METHODS: We retrospectively analyzed the results of 3,537 cases of midtrimester prenatal genetic amniocentesis which were performed from 1994 to June 2006 in the cytogenetic laboratory at Pusan National University Hospital. RESULTS: Of the 3,537 midtrimester amniocentesis cases, the most common maternal age group was 25~29 years old (32.8%), followed by 30-34 years old (32.1%) and 35~39 years old (24.3%). The indications for amniocentesis were abnormal triple test (42.6%), advanced maternal age (31.8%), family history of chromosomal abnormality (7.0%), in the respective order. The overall incidence of chromosomal abnormalities was 5.0%, of which numerical abnormalities and structural abnormalities were 2.4% and 2.6%, respectively. Chromosomal abnormalities were most frequently found in the maternal age over 45 (16.7%), followed by 40~44 years old (6.3%) and 25~29 years old (5.6%). According to the indications of amniocentesis, chromosomal abnormalities were found in patients with habitual abortion (21.2%), previous history of chromosomal abnormality (14.3%), abnormal finding on ultrasonography (11.5%) and advanced maternal age (5.7%), in the respective order. CONCLUSION: In this study, in addition to although abnormal triple test and advanced maternal age as important indications of midtrimester amniocentesis for prenatal diagnosis, other indications such as habitual abortion, previous history of chromosomal abnormality and abnormal finding on ultrasonography should be considered important as indications of midtrimester amniocentesis.

A Case of Fitz-Hugh-Curtis Syndrome which have Direct Adhesion between the Liver Capsule and Adjacent Anterior abdominal Wall / 대한산부인과학회지

Fitz-Hugh-Curtis syndrome means perihepatitis consisting of liver capsule inflammation without parenchymal damage associated with pelvic inflammatory disease (PID). The incidence of this syndrome in PID is reported to be 15-30%. It produces right upper quadrant pain from acute inflammatory reaction between liver capsule and adjacent peritoneum in acute phase, and later forms characteristic violin-string adhesions. Recently, it is suggested that marked hepatic subcapsular enhancement at arterial phase in contrast-enhanced CT has diagnostic value, but diagnostic laparoscopy is used as definitive diagnostic method in Fitz-Hugh-Curtis syndrome. We have experienced one case of Fitz-Hugh-Curtis syndrome in women with right upper quadrant pain, which was diagnosed by CT imaging and was not improved by appropriate antibiotic therapy. In diagnostic laparoscopic examination, we have found direct adhesion between liver capsule and anterior abdominal wall and experienced improvement in symptoms after adhesiolysis. So, we report this case with the brief review of the literatures.

Plasma Androgen and Estrogen Levels in the Third Trimester of Pregnancy in Peeclampsia / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to measure maternal plasma androgens and estrogen levels and to assess the role of these hormones in the pathogenesis of preeclampsia. METHODS: The groups consisted of 28 healthy pregnant women as well as 24 pregnant women with severe preeclampsia. Plasma total testosterone (T), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS) and androstenedione (ADD) levels were measured. Statistical analysis was achieved with Student's t-test by using SPSS for Windows and the Pearson's coefficient of correlation was calculated. RESULTS: No significant differences were observed between the two groups regarding age, gestational age, body mass index, parity, hematocrit and platelet, whereas significant differences were noted regarding systolic and diastolic blood pressure, gestational weeks at delivery, birth weight, serum creatinine, uric acid and urea. In preeclampsia group, serum total testosterone and ADD levels were determined to be higher than the control group (p0.05). Serum testosterone levels were positively correlated with systolic and diastolic pressure and uric acid and negatively correlated with birth weight. CONCLUSION: These results suggest that the elevated plasma levels of testosterone could contribute to the pathogenesis of preeclampsia.

A Case of Immature Ovarian Teratoma Combined with Paraneoplastic Limbic Encephalitis / 대한산부인과학회지

Paraneoplastic limbic encephalitis (PLE) is a rare neurologic disorder that can be combined with several systemic tumor. PLE is commonly associated with small cell lung carcinoma, but others are uncommon. The cause is unknown, but it is thought to be a autoimmune disorder developing secondary to carcinomatous process. Progressive neurologic symptoms usually predate the diagnosis of cancer, most symptoms usually improve after resection of tumor. PLE can combined with several tumors, but it is very rare with immature ovarian teratoma. We report a case of 31-year-old woman with PLE combined with an immature ovarian teratoma whose neurologic symptoms improved after resection of primary tumor.

A Case of Ovarian Cellular Fibroma with Endometriosis / 대한산부인과학회잡지

Ovarian cellular fibroma is an uncommon benign tumor and accounts for approximately 4% of all ovarian neoplasms. It mimics fibrosarcoma histologically because of its rich cellularity and high number of mitoses. Ovarian cellular fibroma with endometriosis was a rare case. We experienced a case of ovarian cellular fibroma in a 25-year-old woman underwent exploratory laparotomy for huge ovarian enlargement and report the case with brief review of literature.

Combination Chemotherapy with High Dose Cisplatin - Cyclophosphamide in Primary Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study was to evaluate the therapeutic efficacy and toxicity of high dose cisplatin-cyclophosphamide combination chemotherapy on patients with primary epithelial ovarian cancer. METHODS: A review of 63 patients previously diagnosed as primary epithelial ovarian cancer after initial operation and histology at Pusan National University Hospital from Jul. 1993 to Jun, 1997 was performed. Patients were received the combination chemotherapy including cisplatin 100mg/m2/day and cyclophosphamide 750mg/m2/day, repeated 6 cycles every 4 weeks. The mean age was 48 years old, and previous surgical procedures were total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy. The patients were classified into FIGO stage and pathologic results. RESULTS: The clinical response rate was 100% in the FIGO stage Ic patients with PC combination chemotherapy, 100% in stage II, 53.5% in stage III, and 25% in stage IV. The overall response rate was 69.8%. The 3-year survival rate according to the treatment groups was 93.3% in stage Ic group, 60% in stage II, 50% in stage III and 0% in stage IV. The mean survival duration was 34.6 months. Hematologic toxicities in cisplatin-cyclophosphamide chemotherapy were neutropenia and anemia. Nausea and vomiting were the most common side effects and occurred in 96.8%. Most of the toxicities were grade 1 and 2. CONCLUSION: The combination chemotherapy with cisplatin-cyclophosphamide is relatively safe and effective method in the treatment of primary epithelial ovarian cancer.