Mesenteric desmoid-type fibromatosis causing secondary hypertension in a young woman

This report describes an 18-year-old woman presenting with abdominal distension, left flank pain, and hypertension. She had a huge abdominal mass, diagnosed as a mesenteric desmoid-type fibromatosis, causing compression of the left external iliac vessels and ureter, as well as elevated renin concentration and hypertension. After surgical removal of the mass, all signs improved including hypertension.

Expression of aromatase in endometiosis and its relation to clinical laboratory and surgical parameters / 대한산부인과학회지

OBJECTIVE: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. METHODS: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. RESULTS: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. CONCLUSION: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.

A case of port site implantation of borderline mucinous tumor of ovary after the laparoscopic operation / 대한산부인과학회지

Borderline tumor of ovary is epithelial proliferation without stromal invasion, first reported by Taylor in 1929. Borderline ovarian tumor occurs in younger women and is detects in early stage. Laparosocopy is alternative treatment of younger women for postoperative quality of life because it reduces postoperative adhesion. But it is limited to incomplete staging, tumor cell dissemination and recurrence. We report a case of port site implantation of mucinous borderline tumor after the laparoscopic operation; usually recurrence of borderline tumors were occurred after ten or fifteen years later, this case a direct evidence of cause of metastasis after the laparoscopic operation.

A case of small bowel obstruction during pregnancy / 대한주산의학회잡지

Small bowel obstruction is an unusual complication of pregnancy, but it is associated with high fetal and maternal mortality. Diagnosis is often delayed due to confusion over symptoms by both the patient and physicians, because symptoms such as colicky abdominal pain, vomiting and constipation are all common at various stages of pregnancy. If is small bowel obstruction of gravid patient suspected, prompt abdominal radiological evaluation and surgical intervention to reduce both maternal and fetal mortality are warranted. We report a recently report a recently experienced case of small bowel obstruction with brief review of literatures.

A case of ovarian endometriosis after laparoscopically assisted vaginal hysterectomy / 대한산부인과학회지

Endometriosis is defined as the presence of endometrial tissue outside the uterus and located usually within the pelvis. It may be detected as a rare complication associated with surgery. Endometriosis following obstetric and gynecologic procedure, which is localized mostly in the surgical scar including Cesarean section scar, hysterotomy scar, trocar scar, Bartholin cyst exision scar, or episiotomy scar, may caused by implantation of endometrial gland and stroma. Endometriosis developing after hysterectomy, especially, is a quite rare condition except a recurrent disease. We have experienced a case of a 47-year-old woman who had diagnosed ovarian endometriosis two years after laparoscopically assisted vaginal hysterectomy for a large leiomyomatous uterus with no evidence of endometriosis, so we report this case with a brief review of literature.

A study on association of progesterone receptor gene polymorphism (PROGINS) with Endometriosis

PURPOSE: Endometriosis is a steroid dependent disease with a particular genetic background but the location of possible genomic aberrations are still poorly clarified. This study was designed to investigate the associations between the polymorphism of the progesterone receptor gene (PROGINS) and endometriosis. METHODS: 100 women with surgically diagnosed and histologically confirmed endometriosis were enrolled as a patient population and a total of 110 female control subjects undergoing health examination were enrolled as control population. DNA extraction and polymerase chain reaction (PCR) were used to genotype women for the presence of the PROGINS polymorphism in peripheral blood samples. The x2-test was used to compare genotype distributions between endometriosis and controls. RESULTS: T1/T2 heterozygote was found to be one patient in each group, and the rest of the subjects were all T1/T1 homozygotes. There was no difference in the genotype distribution between the endometriosis group and the control group. CONCLUSION: These results suggest that the progesterone receptor gene PROGINS is not associated with the risk for endometriosis.

The Effect of Vero Cell Coculture on the Development of Mouse Embryos Exposed to Monoclonal Antibodies Specific for Mammalian Heat Shock Protein 60

Heat shock proteins (HSP) have been identified as an important factor of a very complex and highly conserved cellular defense mechanism to preserve cell survival under adverse environmental conditions. HSP 60 are immunodominant antigens of microbe such as Chlamydia trachomatis and have a potentiality to become a target antigen due to antigenic similarity between chlamydial and human HSP. This study was conducted to investigate the effects of Vero cell coculture to anti-HSP 60 on the early mouse embryo development in vitro. The 2-cell mouse embryos (ICR) were cultured and mouse embryo development was observed every 24 hr for 3 days. 45% and 22.1% of the embryos cultured in Ham's F-10 plus anti HSP 60 with Vero cells developed to the 4- to 8- cell stage (day 1) and morular stage (day 2) as compared with 29.2% and 2.7% of those cultured without Vero cells respectively. But at day 3, the beneficial effect of Vero cells was not noted. These findings suggest that Vero cells have some roles to overcome the detrimental effect of anti-HSP 60 to some degree. These results suggest that Vero cells coculture will promote reproductive outcome in patient previously sensitized to microbial (e.g. Chlamydia trachomatis) HSP 60.

Association of Progesterone Receptor Gene Polymorphism (PROGINS) and Estrogen Receptor Gene Polymorphism with Endometriosis in Korean Population / 대한산부인과학회지

OBJECTIVE: Endometriosis is defined as the presence of endometrial tissue outside the uterus, causing diverse progressive diseases such as infertility, pelvic pain, and dysmenorrhea. Although the mechanisms responsible for its pathogenesis and progression remain poorly understood, it is well established that endometriosis grows and regresses in an estrogen-dependent fashion and that administration of progestin can relieve the symptoms caused by endometriosis. Some genetic studies have demonstrated the association between the estrogen or progesterone receptor gene polymorphism and the susceptibility to endometriosis. This study was designed to investigate the associations of the polymorphism of the progesterone receptor gene (PROGINS), PvuII and XbaI polymorphism of estrogen alpha receptor gene with endometriosis in the Korean population. METHODS: A total of 100 women with surgically diagnosed and histologically confirmed endometriosis of stage III-IV were enrolled as a patient population and a total of 110 female control subjects undergoing health examination were enrolled as control population. Following isolation of genomic DNA from peripheral blood, polymerase chain reaction-sequence specific primer assays were performed for analyzing progesterone receptor gene polymorphism (PROGINS) and polymerase chain reaction-restriction fragment length polymorphism assays were performed for analyzing estrogen alpha receptor gene PvuII and XbaI polymorphism. The chi-square-test was used to compare genotype distributions between endometriosis and controls. RESULTS: Only one patient in each group was found to be T1/T2 heterozygote, and the rest of the subjects were all T1/T1 homozygotes. Analysis of PvuII has shown that the significantly lower number of patients had (pp) genotypes and (p) alleles in the endometriosis group compared with the control group (32 (32%) vs. 50 (45.5%), P<0.05; 109 (54.5%) vs. 142 (64.5%), P<0.05, respectively). There was no difference in the genotype distribution or allele frequency in XbaI polymorphism between the endometriosis group and the control group. CONCLUSION: These results suggest that the PvuII polymorphism of the estrogen receptor-alpha gene is associated with the risk for endometriosis in the Korean population.

The Effects of Vero Cell Co-culture on the Expression of Bax and Bcl-2 Genes in the Mouse Embryo Development / 대한산부인과학회지

OBJECTIVE: To investigate the effects of Vero cell co-culture on the development of mouse embryo in vitro and the expression of bax and bcl-2 genes in the mouse embryo. METHODS: The 2-cell mouse embryos were obtained from oviduct of 5-6 weeks old mated female ICR mice superovulated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). The 2-cell embryos in Ham's F-10 medium supplemented with 10% FBS with or without Vero cells, were incubated at 37 degrees C in a 5% CO2 humidified air chamber respectively and we observed mouse embryo development and collected each group of embryos for the purpose of extraction of total RNA every 24 hours for 3 days. We carried out the RT-PCR to assess mRNA levels for bax and bcl-2 gene. RESULTS: The rate of embryo development of with Vero cell co-cultured group was 78.3%, 50.7%, 27.2% and that of without Vero cell co- cultured group was 60.5%, 29.3%, 20.7% respectively. Bax mRNA expression level of without Vero cell co-cultured group was significantly higher than that of with Vero cell co-cultured group at 24 hours. Bcl-2 mRNA expression level of Vero cell co-cultured group was significantly higher than that of without Vero cell co-cultured group at 72 hours. CONCLUSION: These findings suggested that Vero cell co-culture is beneficial in the development of mouse embryos and stimulates bax and bcl-2 gene expression.

Three Cases of Immature Teratoma of the Ovary / 대한산부인과학회잡지

The immature teratoma is the 3rd most common germ cell tumor and represents 10-20% of all ovarian malignancies occurring in the first two decades of life. The initial clinical manifestation is abdominal/pelvic mass with pain. This tumor is usually unilateral and large, and has a prominent solid component with cystic elements. It is composed of mature and immature tissues derived from the three germ cell layers. Tumor grading is based on the amount of immature tissues which mostly derives from neuroectodermal origin. The prognosis and treatment depend on the clinical stage and histological grade of the tumor. The initial treatment should include unilateral salpingo-oophorectomy and removal of as much extraovarian tumor as possible. Adjuvant chemotherapy is not necessary for the patients with stage IA, grade 1 tumor or those with mature glial implants. Combination chemotherapy is recommended for the patients with grade 2 or 3 tumors or those with immature metastases. Although the immature teratoma was considered aggressive tumor type before the prevalent use of chemotherapy, the advances in combination chemotherapy have leaded to the better prognosis than before. We have experienced three cases of immature teratoma and report them with brief review of literatures.

A Case of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary carcinoma of the fallopian tube is very rare and accounts for less than 1% of all gynecologic malignancies. Nonspecific symptoms are presented, so primary carcinoma of the fallopian tube was confirmed postoperatively on the basis of the pathologic examination. The evaluation and treatment are similar to that of the ovarian cancer. We have experienced a case of primary carcinoma of the fallopian tube, especially fimbrial portion and report with a brief review of the literature

A Case of Huge Ovarian Tumor Associated with Hypothyroidism / 대한산부인과학회잡지

In adult women, hypothyroidism has significant effect on reproduction. Hypothyroidism is associated with oligomenorrhea, amenorrhea, anovulation, hypermenorrhea, menorrhagia, infertility, spontaneous abortion, stillbirth or preterm delivery. It can cause ovarian tumor, which clinically resembles ovarian hyperstimulation syndrome or multicystic ovarian tumor. We have experienced a case of spontaneously regressed huge ovarian tumor which was found in patient. With hypothyroidism. So we report this case with a brief review of literature.

Studies on Fibrinolytic System Behavior in Women with Polycystic Ovary Syndrome / 대한산부인과학회잡지

OBJECTIVE: To evaluate the plasma concentration of plasminogen activator inhibitor 1, main regulator of fibrinolytic system in women with polycystic ovary syndrome and to clarify whether it may be involved in the pathogenesis of chronic anovulation. METHODS: Fibrinolytic system (plasma fibrinogen, plasminogen, plasminogen activator inhibitor 1 concentration) was assayed in women with polycystic ovary syndrome and compared to normal controls. RESULTS: Women with polycystic ovary syndrome had significantly higher plasminogen activator inhibitor 1 and fibrinogen concentration compared to normal controls. CONCLUSION: Women with polycystic ovary syndrome may have an imbalance in the fibrinolytic system that is tilted towards a reduced production of the proteolytic enzyme plasmin. It may result in impaired follicular rupture and anovulation at cellular level in the ovaries.

Comparison of Expression of Endometrial Prolactin in infertile Women with Luteal Phase Defect According to Clomiphene Citrate Administration / 대한불임학회지

OBJECTIVE Clomiphene citrate is one of the most commonly used drugs in the treatment of infertility, but the pregnancy rate achieved with clomiphene citrate is significantly lower than the ovulation rate due to its antiestrogenic effect on the endometrium. Endometrial prolactin is considered to be a marker and an inducer of predecidualization that is characteristic of secretory endometrium. The purpose of this study was to evaluate the association of clomiphene citrate and unsatisfactory endometrial differentiation to secretory endometrium by examining the endometrial expression of prolactin in clomiphene citrate-treated infertile women with luteal phase defect. METHODS: The endometrial samples from infertIle women wIth luteal phase defect (n=27) were examined. Five cases during secretory phase and six cases during proliferative phase were obtained by biopsy. Sixteen cases were obtained by biopsy during secretory phase after clomiphene citrate treatment. By immunohistochemical staining for prolactin, all obtained endometrial tissues were examined. The differences in the endometrial expression of prolactin were evaluated between proliferative phase and secretory phase, and between clomiphene citrate treated group and no treatment group during secretory phase. RESULTS: The staining of endometrial prolactin was significantly more intense in the glandular epithelial cells and stromal cells in the secretory endometrium than in the proliferative endometrium. The glandular expression of prolactin in the secretory endometrium was not significantly different between the clomiphene citrate-treated group and no treatment group (p=0.719), but the staining of prolactin in the stromal cells was significantly less intense in the clomiphene citrate-treated group than no treatment group (p=0.019). CONCLUSION: in this investigation, we demonstrated that the endometrial stromal expression of prolactin in the secretory phase was significantly lower in the clomiphene citrate-treated group campared with no treatment group in infertile women with luteal phase defect. And our finding suggests that clomiphene citrate may have an adverse effect on the endometrial predecidualization in infertile women.

The Effect of Equilibration Temperature and Time Prior to Cryopreservation on the Outcome of Cryopreservation of 2-Cell Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: One-cell human zygotes have been successfully frozen and thawed using 1,2-propanediol (PROH) during freezing and thawing. This study was performed to assess the effect of equilibration temperature and time on cryopreservation of 2-cell mouse embryos by investigating the equilibration temperature and time during initial PROH exposure prior to cryopreservation. MATERIALS AND METHODS: The late 2-cell mouse embryos were obtained from 5-6 week old ICR mice and were exposed to 1.5 M PROH in phosphate-buffered saline (PROH-PBS) at 37degrees C, room temperature (22- 24degrees C), and 4degrees C for 30 min. The PROH was washed off the 2-cell mouse embyos by incubating them for 5 min each in 1, 0.5, and then 0 M PROH-PBS in the order named. The 2-cell mouse embryos were subsequently cultured in Ham's F-10 medium and embryo development was assessed at 24, 48, and 96 hours. RESULTS: Incubation of 2-cell mouse embryos at 37degrees C for 30 min significantly impaired embryo development to blastocysts. Embryo development after exposure to PROH at 37degrees C for 10 min was 8.3% (P=0.047) and embryo development for 30 min was 5.4% (P=0.038). Incubation of 2-cell mouse embryos at room temperature or 4degrees C for up to 30 min did not significantly reduce embryo development. Cryosurvival of 2-cell mouse embryos exposed to PROH at room temperature or 4degrees C was similar. CONCLUSION: These findings suggested that pronanediol is toxic to 2-cell mouse embryos in a temperature- and time-dependent fashion. Cryopreservation of 2-cell mouse embryos after exposure at 4degrees C appears to be no better than after exposure at room temperature.

A Case of Peripartum Cardiomyopathy / 대한산부인과학회잡지

Peripartum cardiomyopathy is relatively uncommon form of heart failure that occurs from one month before, to 5 months after delivery. The causes of this disease are unknown and mortality rate may be as high as 20-50%. We recently experienced one case of this disease and summarized here with brief review of literatures.

Studies on the Effects of Monoclonal Antibodies to Mammalian Heat Shock Protein 60 (HSP 60) on Mouse Embryo Development In Vitro / 대한산부인과학회잡지

OBJECTIVE: To investigate the effects of antibodies to HSP 60 on the early mouse embryo development in vitro. METHODS: The 175 late 2-cell mouse embryos were obtained from 6-7 week old female ICR mice. 5-10 embryos were placed in each well. The embryos were incubated in the Ham's F-10 medium supplemented with 100 microgram/mL of monoclonal antibody to HSP 60 (66), monoclonal mouse IgG1 (55), and medium alone (54), respectively, at 37degrees C in a 5% CO2 humidified air chamber, and mouse embryo developments were observed daily. RESULTS: On day4, growth arrests were more prominent in anti-HSP 60 containing group compared to IgG1 containing group, medium only group (0% vs 16%, 14%), and these results were statistically significant (p=0.0032). Especially those inhibitory effects were observed in early stage of embryo development (day1) and these results were also statistically significant (31% vs 83%, 77%, p<0.0001). Moreover, we found out that cellular degenerations were more common in anti-HSP 60 containing group and this features were prominent on day2. CONCLUSION: Anti-HSP 60 elicited a strong growth inhibitory and degenerative effect on early mouse embryo development. These findings suggest that HSP 60 may exert a protective effect against mouse embryo degeneration or apoptosis.

A Case of Holoprosencephaly / 대한산부인과학회잡지

Holoprosencephaly is a rare developmental defect due to incomplete cleavages of the prosencephalon during the third week of fetal development. It was associated with chromosomal anomalies, genetic syndrome, teratogen, or genetic disorder of non-syndromic HPE. Early antenatal detection of holoprosencephaly was done by high resolution ultrasonography. According to its severity and prognosis, it was capable of proper treatment of holoprosencephaly. We report one case of holoprosencephaly with a brief review of the literature

Studies on Pregnanacy Rate of Controlled Ovarian Hyperstimulation before Intrauterine Insemination in the Treatment of Unexplained Infertility / 대한산부인과학회잡지

OBJECTIVE: To determine which regimen for controlled ovarian hyperstimulation is the most effective in achieving pregnancy after intrauterine insemination in the treatment of unexplained infertility. MATERIALS AND METHODS: From March 1996 to February 2000, a total of 67 cycles of intrauterine insemination after controlled ovarian hyperstimulation were treated in 39 patients under 40 years old who diagnosed as unexplained infertility. Two methods of controlled ovarian hyperstimulation were used. The one is clomiphene citrate/hMG and the other is hMG only. These were compared the pregnancy rate respectively. RESULTS: Mean age of study group was 32+/-2.7 years old (28-38 years old) and mean duration of infertility was 46+/-17.8 months (15-96 months). The overall clinical pregnancy rate was 17.9% (12/67 cycle) per cycle and 30.7% (12/39 patient) per patient. According to the methods of controlled ovarian hyperstimulation, pregnancy rate was 16.7% (8/48 cycle) after clomiphene citrate/hMG used, 21.1% (4/19 cycle) after hMG only used. 4 cases of ovarian hyperstimulation syndrome developed (clomiphene citrate/hMG 1 case, hMG only 3 cases) and all of them were self-regressed. CONCLUSION: Compared with using hMG only as controlled ovarian hyperstimulation before intrauterine insemination, using clomiphene citrate/hMG was more effective regimen and considered as the first choice in the treatment of unexplained infertility.

Effects of Coculture of Vero Cells on the Development of Frozen-thawed Two-cell Stage ICR Mouse Embryos / 대한산부인과학회잡지

OBJECTIVE: The rate of developmental progression of frozen-thawed embryos is lower than that of nonfrozen embryos in mice, cows, humans and other mammalians. This study was designed and performed to evaluate the beneficial effects of coculture of Vero cells on the development of frozen-thawed two-cell stage embryos of ICR strain mice. MATERIASL AND METHODS: The late two-cell stage mouse embryos were obtained from oviducts of 5~6 week old mated ICR mice superovulated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Two-cell stage mouse embryos were frozen slowly with 1,2-propanediol and sucrose as cryoprotectants and thawed rapidly, followed by stepwise dilution. The frozen-thawed embryos were cultured in Ham's F-10+10% Fetal Bovine Serum (FBS) basal culture medium with and without Vero cells. The rates of development in both groups were compared every 24 hours for 5 days. RESULTS: Vero cells did not significantly stimulate the rate of embryonal development compared to controls at 24 hours after culture, 124 (69.3%) and 68 (61.3%), respectively (p=0.161). On day 4, however, 55 (30.7%) cocultured embryos had developed to expanded-hatching blastocysts, which was the significantly higher number than that of the embryos in controls: 16 (14.4%) (p=0.002). In addition, more embryos in coculture developed to hatching-hatched blastocysts (43[24.0%]) compared to the controls (10[9.0%]) (p=0.001). CONCLUSION: Coculture of cryopreserved embryos after thawing with Vero cells seems to be an useful tool to remove the postthaw deleterious effects of freezing and to obtain better quality embryos appropriate for transfer. These beneficial effects of Vero cell coculture appear to become more prominent as the embryonic development progresses over time.