Do endometrial movements affect the achievement of pregnancy during intrauterine insemination?

This study was aimed to assess the effect of endometrial movements on pregnancy achievement in intrauterine insemination [IUI] cycles. The population of this observational study was composed of unexplained infertility couples undergoing first-time IUI with clomiphene citrate between September 2010 and October 2011. Not only endometrial movements, but also thickness, volume, pattern, and echogenic change of endometrium were analyzed prospectively in prediction of pregnancy. The total number of 241 cycles of IUI with 49 intrauterine pregnancies [20.3%] was analyzed. Pregnancy was not related to endometrial thickness and endometrial volume, but significantly related to endometrial movements associated with the number of contraction, strong movement, cervicofundal direction, and hyperechoic change [p<0.05]. Pregnant group showed higher cervicofundal movement rate [89.8 vs. 75.5%]. For IUI cycles stimulated by clomiphene citrate in unexplained infertility women, endometrial movements on the day of IUI could be a predictor of pregnancy

Association between Serum Homocysteine Concentrations and Bone Mineral Density in Middle Aged Women / 대한폐경학회지

OBJECTIVES: Hyperhomocysteinemia is known to be related with the early onset of osteoporosis. This study was to examine the association between serem homocysteine levels and bone mineral density (BMD) in middle aged women. METHODS: The study included 409 women who underwent bone density tests in the health screening centers from January 2009 to october 2010. Serum homocysteine levels and BMD were measured. RESULTS: Postmenopause group (n = 109) showed significantly lower BMD score in lumbar spine and femoral neck and significantly higher serum homocysteine concentration compared to premenopause group (n = 300). However, after adjusting for age, body mass index, and the menopausal condition in total 409 women, there were no significant correlations between serum homocysteine levels and BMD. CONCLUSION: Measurement of serum homocysteine levels may not be useful, but adjunctive for the risk assessment of osteoporosis in middle aged women.

Primary extraskeletal mesenchymal chondrosarcoma of the vulva

Extraskeletal chondrosarcoma is rare, making up only 1% of reported chondrosarcoma. We experienced 3 cases of extraskeletal chondrosarcoma, especially in vulva. They were suspected as lipoma of the vulva. The patients had noticed a small but growing mass on their vulva which had been palpated earlier. The masses were excised with a 2 cm resection margin. The final pathological reports confirmed extraskeletal mesenchymal chondrosarcoma (EMC) of the vulva revealing no microscopic lesions on the resection margins. After 24 months of following from the initial diagnosis, the patients remain without evidence of any recurrent. Management of EMC is not well studied due to the rare and variable nature of the disease. However, the surgery, such as we had, is the mainstay of local treatment with studies showing better survival in patients who undergo wide surgical resection. The establishment of adjuvant systemic pharmacotherapy could be expected in the future.

Effect on Bone Mineral Density in Postmenopausal Invasive Cervical Cancer Patients with Radical Operation and CCRT / 대한골다공증학회지

OBJECTIVES: This study evaluated the effect on bone mineral density (BMD) in postmenopausal invasive cervical cancer patients treated with radical operation and concurrent chemoradiotherapy (CCRT). METHODS: We analyzed the BMD of spinal bone and the femur in 48 invasive cervical cancer patients treated with CCRT after radical operation. All BMD was measured by dual-energy X-ray absorptiometry. For comparison with control women, 96 patients without gynecological disease whose age and body mass index are consistent with the case group were selected. The measurement interval was 1 year. All of the patients and control women had reached their menopause. RESULTS: Age, height, body weight and body mass index were not significantly different between the two groups. The serum levels of calcium and phosphate were not significantly different between the patients with cervical cancer and control women before and after treatment. On the other hands, the concentrations of total alkaline phosphatase and osteocalcin of patients with invasive cervical cancer were significantly lower (P<0.05) than those of control women after treatment. BMD showed inconsistent outcomes, but there is a trend of decrease after operation and CCRT in invasive cervical cancer. CONCLUSIONS: Our study suggests that invasive cervical cancer patients treated with radical operation and CCRT have a lower BMD, resulting in an increased risk of osteoporosis.

A Retrospective Study of Bone Mineral Density in Patients with Endometrial Cancer without Bone Metastases / 대한골다공증학회지

OBJECTIVES: This retrospective study evaluated bone mineral density (BMD) in postmenopausal endometrial cancer patients without bone metastases. MATERIALS AND METHODS: We retrospectively analyzed the BMD of spinal bone and the femur in 26 endometrial cancer patients and 32 control women. All of the patients and control women had reached their menopause. The control group was treated with benign uterine myoma whose age and body mass index are consistent with the case group. All BMD was measured by dual-energy X-ray absorptiometry.

Effect of Black Cohosh on Genital Atrophy and Its Adverse Effect in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: It is to evaluate the effect of black cohosh on genital atrophy and its adverse effect in postmenopausal women. METHODS: A total of 100 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive black cohosh combined proparation (n = 50) or placebo (n = 50) daily for 12 weeks. A total of seventy eight subjects completed the study. The effect of black cohosh on vaginal atrophy was evaluated by measuring Maturation value (MV). MV was determined from vaginal smear at 0 and 12 weeks of treatment. Safety assessment included vital signs, physical examinations, adverse events, and routine laboratory parameters. Assessments were carried out at the beginning, and after 4, 8, and 12 weeks of treatment. RESULTS: The mean (+/- standard deviation) MV decreased 0.18 (0.48 +/- 0.33 to 0.30 +/- 0.24) in the black cohosh group and 0.13 (0.44 +/- 0.31 to 0.31 +/- 0.22) in the placebo group. There was no statistical difference between the groups. But adverse events were observed in 7 (14%) patients in the black cohosh group and 6 (12%) patients in the placebo group, without statistical significance. No significant effects were observed on blood pressure, heart rate, body temperature, physical findings, and laboratory values. Black cohosh was well tolerated. CONCLUSION: Black cohosh did not exert estrogenic effects with regards to vaginal atrophy. Further studies on the long-term safety and the appropriate doses of cohosh are needed.

Recent Trends in Chronic Pelvic Pain Diagnosis / 고신대학교의과대학학술지

Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. The initial history and physical examination can narrow the diagnostic possibilities, guide any subsequent evaluation, and rule out malignancy or significant systemic disease. If the initial evaluation does not reveal a specific diagnosis, a limited laboratory and ultrasound evaluation can clarify the diagnosis, as well as rule out serious disease and reassure the patient. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations.

Decreased Bone Mineral density of Spine in Patients with Invasive Cervical Cancer / 대한골다공증학회지

OBJECTIVES: To investigate the spinal bone mineral density (BMD) in patients with invasive cervical cancer without bone metastases. METHODS: We measured spinal bone mineral densities by dual-photon absorptiometry in 119 patients with invasive uterine cervical cancer and compared them with measurements from 135 control women. RESULTS: When adjusted for age, mean bone mineral density in patients with uterine cervical cancer was 13.9% lower (P=0.0003) and age-matched percentiles were 9.2% lower (P=0.0003) than in control women. The deficits in bone mineral density and age-matched percentiles were confined to the uterine cervical cancer patients in their fifties. CONCLUSIONS: Our study results suggest that patients with invasive cervical cancer have a lower spinal BMD, resulting in an increased risk of osteoporosis.

The Study of Bisphosphonate and Postmenopausal Hormone Treatment in Low Bone Mineral Density / 대한골다공증학회지

OBJECTIVES: To evaluate the effect of postmenopausal hormone therapy alone or in combination with bisphosphonate on bone mineral density (BMD) in postmenopausal women. METHODS: One hundred three women diagnosed with low BMD in postmenopausal women were included in this study. All patients were classified into two groups; oarl hormone therpy alone (Group I) or with alendronate (Group II), given for 12 months. Dual energy X-ray absorptiometry was used to measure BMD before and after 12 months of treatment. RESULTS: In all groups, significant increase in bone density measurements were seen at 12 months of treatment. The BMD of lumbar spine more increased significantly in Group II than Group I. CONCLUSIONS: Postmenopausal hormone therapy is effective in osteopenic and osteoporotic women. However, the combined treatment with hormone therapy and bisphophonate is more effective in postmenopausal women with low BMD.

Gestational trophoblastic disease in a patient with twin pregnancy consisting of complete hydatidiform mole and co-existing live fetus after in vitro fertilization / 대한산부인과학회지

A 45-year-old, multigravida woman who had been pregnant with dichorionic twins after in vitro fertilization (IVF) was referred due to early onset of severe preeclampsia. Ultrasonographic findings were multicystic tumor and normal placenta with a live fetus appropriate for 14 weeks of gestation. After therapeutic abortion, the multicystic tumor showed hydropic feature. The fetus had no anomalous finding. Histopathologic analysis revealed complete hydatidiform mole and normal placental tissue attaching three vesseled umbilical cord. Gestational trophoblastic disease (GTD) was diagnosed due to rising levels of serial beta-hCG values and abnormal sonographic findings. The patient treated with combined chemotherapy. We report a case of a complete hydatidiform mole and coexisting normal live fetus after IVF, which was complicated with early onset severe preeclampsia and persistent GTD.

The expression of Thymosin beta4 with angiogenic factors in epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to determine thymosin beta4 expression in epithelial ovarian cancer compared to normal ovarian tissue. METHODS: Normal and pathologic ovarian tissues were obtained from healthy women (n=18), and from patients with ovarian cancer (n=27). The expression of thymosin beta4 mRNA was examined by quantitative competitive polymerase chain reaction (QC PCR). Thymosin beta4 mRNA expression was examined with angiopoietic factors such as vascular endothelial growth factor, angiopoietin-1 and 2. RESULTS: The expression of thymosin beta4 mRNA in epithelial ovarian cancer was higher than that in the normal ovary (p<0.05). Thymosin beta4 mRNA expression was not correlated with ovarian cancer stages, pathologic types, preoperative CA125 levels, or metastasis to lymph nodes but was correlated with the expression vascular endothelial growth factor and angiopoietin-2 (p<0.05). CONCLUSIONS: Our results suggest that overexpression of thymosin beta4 mRNA may be a biologic marker to differentiate epithelial ovarian cancer from normal ovary and it may play a role in angiogenesis of epithelial ovarian cancer.

The role of transvaginal sonography at early pregnancy in prediction of placenta previa / 대한산부인과학회지

OBJECTIVE: Ultrasonography was used to determine not only the size but also the shape and site of gestational sac (GS) in early pregnancy. This study was performed to evaluate the role of transvaginal ultrasonography to predict placenta previa in early pregnancy, and analyze the correlation of the GS location with pregnancy outcomes. METHODS: From 1995 to 2007, medical records of pregnant women who had diagnosed placenta previa at Kangnam St. Mary's Hospital and Our Lady of Mercy Hospital were reviewed retrospectively. 71 patients with placenta previa had transvaginal ultrasonographic evidences within 7 weeks of gestation. As a control group, randomized sampling among pregnant women without placenta previa was performed, and 102 patients were selected and reviewed. Data was analyzed with SPSS version 11.0 statistically. RESULTS: 23.9% of GS (n=17) were found in lower 1/3 of the uterine cavity, 31.0% (n=22) were in middle 1/3, while 45.1% (n=32) were in upper 1/3. The distribution of GS in placenta previa patients leans to the lower in uterine cavity compared to normal pregnancies significantly (P=0.000). The relationship between the location of GS and differential diagnosis of placental previa was not statistically significant. CONCLUSION: Our results show that there would be higher risk for placenta previa, preterm labor, and early delivery when ultrasonographic finding of GS within 7 weeks of gestation reveals lower implantation in uterine cavity.

Differential gene expression of transglutaminase 2 in term pregnancy with and without labor / 대한산부인과학회지

OBJECTIVE: Our purpose was to investigate transglutaminase 2 (TGM2) mRNA and protein expressions in term placentas and fetal membranes delivered with labor compared to no labor. METHODS: Samples were obtained from five cases delivered with labor and five cases delivered without labor after 38 weeks of gestation. Each sample was collected from amnion, chorion, central and peripheral portion of the basal plate of placenta. Real time polymerase chain reaction (RT-PCR) was done to analyze mRNA expression of TGM2. Western blot was done and TGM2 protein level was detected. Mann-Whitney U test was used for statistic analysis. RESULTS: In labor group, TGM2 mRNA expressions were decreased compared to no labor group in 3 sampling sites except chorion (0.66+/-0.10 vs 1.29+/-0.12 in peripheral placenta, 0.67+/-0.23 vs 1.02+/-0.02 in central placenta, 0.70+/-0.16 vs 1.04+/-0.05 in amnion in contrast with 1.62+/-0.64 vs 1.56+/-0.21 in chorion). TGM2 protein expressions of four differential portions were decreased in all labor groups (1.05+/-0.35 vs 1.27+/-0.19 in peripheral placenta, 0.69+/-0.84 vs 0.84+/-0.31 in central placenta, 0.33+/-0.15 vs 0.39+/-0.33 in amnion, 0.96+/-0.18 vs 1.77+/-0.61 in chorion). CONCLUSIONS: This result suggests that TGM2 might involve in labor progress of term pregnancy.

The effect of oligohydramnios on the adverse perinatal outcome and clinical characteristics in uncomplicated term pregnancies / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the effect of the isolated oligohydramnios on the perinatal outcome in uncomplicated term pregnancies. METHODS: We used data from Jan 2002 to Dec 2005 in all uncomplicated pregnancies between 37 and 41weeks and 6 days of gestation with a singleton fetus, underwent monitoring with serial determination of AFI. Oligohydramnios was defined by ultrasonographic determination of AFI < or =5 cm. Exclusion criteria were PROM, maternal medical complications and fetal anomalies detected by prenatal ultrasound. We investigated the mode of delivery, birth weight, birth weight <10th percentile, 1 and 5 min Apgar score, umbilical cord pH and base excess, and meconium stained amniotic fluid (MSAF). We also assessed the predictive value of obstetric factors associated with adverse perinatal outcome. We used statistics analysis by Chi-square test, independent-samples T test using SPSS 14.0 V. RESULTS: 2,491 patients met our inclusion criteria. Oligohydramnios was diagnosed in 8.63% (215/2,491). There was significantly difference in cesarean section for fetal distress between those with oligohydramnios vs. normal AFI (43.8% vs.4.1%). Patients with oligohydramnios had significantly lower SGA (15.3% vs. 5.7%), lower Apgar score at 1 min<7 (7.9% vs. 3.3%), and higher rate of MSAF (31.2% vs. 18.4%) than those with normal AFI. There were musculoskeletal abnormalities in 10/215 (4.6%) and urogenital abnomralites in 53/215 (24.6%). CONCLUSION: Isolated oligohydramnios in uncomplicated term pregnancies is associated with an increased adverse perinatal outcome. Nulliparity, advanced maternal age, MSAF, SGA, and lower BPP were significantly associated with the adverse perinatal outcomes.

A Clinical Study of Maternal Heart Disease in Pregnancy / 대한주산의학회잡지

OBJECTIVE:To assess the pregnancy outcomes complicated by maternal heart diseases. METHODS:From 1995 to 2006, medical records of pregnant women who had received full antenatal care at Kangnam St. Marys Hospital and Our Lady of Mercy Hospital with maternal heart diseases were reviewed. RESULTS:Forty one deliveries from 39 women were enrolled for analysis. 11 (26.7%) cases of the heart diseases were of rheumatic origin, 22 (53.7%) cases had arrhythmic disease, 3 (7.3%) cases had congenital heart disease, and the remaining 5 (12.3%) cases were consisted of miscellaneous diseases such as ischemic heart disease and congestive heart failure. There were 4 (9.8%) cases of pulmonary edema which had occurred as maternal complication during pregnancy. One case was a twin pregnancy. All of them were in New York Heart Association (NYHA) functional classes I, II before, during, and after delivery. Mean gestational age at birth and birth weight were 38.6 weeks and 3,157 g respectively. Neonatal congenital heart disease was shown in only one case with tetralogy of Falot and the other fetal anomaly was multicystic dysplastic kidney. CONCLUSION:Our results indicate that successful pregnancy outcome in patients with maternal heart disease would be possible in NYHA functional classes of I and II without any increased risk of complications.

Differential Gene Expression in Placenta of Term Pregnant Women with and without Labor using cDNA Microarray / 대한주산의학회잡지

OBJECTIVE:cDNA microarray technology was used to comprehensively analyze the gene expression in the placenta of term women with labor compared to without labor. METHODS:Placental tissue was obtained from patients in spontaneous labor (n=5) and those not in labor (n=5) during Cesarean section of full term pregnancy. mRNA levels were examined through cDNA microarray using Agilent GeneSpringGX 7.3 (Agilent technology, USA). SPSS 11.0 was used for statistical analysis. RESULTS:Among total 38,467 genes, 2,374 genes were detected to be up-regulated in labor samples, while 12 genes were down-regulated. 40 genes of them were identified as significantly up-regulated in levels of expression (up-regulated > or =5.0 fold, p<0.05). According to gene ontology analysis, they are associated with variable cell biologic functions including apoptosis, signal transduction, metabolic process, immune response, and transcription, etc. CONCLUSION:This study suggests that our results could provide interesting clues to understanding the initiation and the process of normal labor and might lead to further studies in a more targeted fashion.

The Study of 5,10-Methylenetetrahydrofolate Reductase Polymorphism and Its Effect on Pregnancy Outcomes among the Korean Population / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to analyze MTHFR polymorphism among the Korean population and to evaluate the relationship between serum levels of homocysteine and MTHFR polymorphism and also to investigate the effect on pregnancy outcomes. METHODS: DNA was extracted from whole blood of 600 pregnant women. All samples were genotyped for the C677T and A1298C polymorphisms in MTHFR gene by PCR-RELP assay. Serum levels of homocysteine and folate were measured by high performance liquid chromatography for homocysteine and radioassay for folate. Pregnancy outcomes were estimated by gestational weeks and birth weights of newborns. RESULTS: Serum homocysteine was higher in women with the T/T genotype than those with the C/T or C/C genotype of the MTHFR C677T polymorphism (p<0.05). And also serum homocysteine was higher in women with the A/A genotype than those with the A/C or C/C genotype of the MTHFR A1298C polymorphism (p<0.05). Serum homocysteine was negatively correlated with serum folate in all MTHFR genotypes, especially prominent in T/T genotype of MTHFR C677T polymorphism and A/A genotype of MTHFR A1298C polymorphism. Gestational age and the birth weight of infant from hyperhomocysteinemic mothers whose homocysteine levels higher than 15 micromol/L were 36.1 weeks, 3053.8g, respectively, which were significant lower than those from normohomocysteinemic mothers (38.3 weeks, 3,215.3g) (p<0.05). CONCLUSION: Serum homocysteine was influenced significantly by MTHFR C677T polymorphism and MTHFR A1298C polymorphism. MTHFR C677T and A1298C polymorphism and serum homocysteine levels affect pregnancy outcomes, although not mainly by serum folate level.

Expression of Angiopoietin-1 and -2 and Tie-2 mRNA in Uterine Endometrial Cancer / 대한산부인과학회지

OBJECTIVE: This study was purposed to investigate the expression of angiopoietin (Ang) -1 and -2 and Tie-2 mRNA among uterine endometrial cancer, endometrial hyperplasia, and normal endometrium, and to assess the relationships among their expression and other prognostic factors of uterine endometrial cancer. METHODS: The tissues were obtained from patients with uterine endometrial cancer, patients with endometrial hyperplasia, and patients with normal endometrium undergoing hysterectomy. Total RNA was extracted and reverse transcribed into cDNA. Reverse transcription polymerase chain reaction (RT-PCR) and quantitative competitive-PCR (QC-PCR) were performed to evaluate the mRNA expressions of Ang-1 and -2 and Tie-2. Clinicopathologic factors of uterine endometrial cancer were reviewed with the patient's charts and results were analyzed with Mann-Whitney U test, Spearman correlation test and logistic regression analysis. RESULTS: Ang-1 and -2 mRNA expression in uetrine endometrial cancer were higher than that in endometrial hyperplasia and lower than that in normal endometrium (p<0.05), but there was no significant difference in Tie-2 mRNA expression among uterine endometrial cancer, endometrial hyperplasia, and normal endometrium. A definite correlation was found between Ang-1 mRNA expression and clinical stage and CA-125 levels of uterine endometrial cancer (p<0.05). CONCLUSION: The expression of Ang-1 and -2 mRNA could be associated with the progression of uterine endometrial cancer and might have a role as prognostic parameters in uterine endometrial cancer.

The Association of Fetal Heart Rate Pattern following Cordocentesis with Pregnancy outcome / 대한산부인과학회잡지

OBJECTIVE: The cordocentesis is regarded as an useful procedure for the prenatal evaluation of fetal disease, but it's complications are fetal loss, umbilical cord bleeding, umbilical cord hematoma, fetal bradycardia, fetomaternal hemorrhage, abruptio placentae, and chorioamnionitis due to it's invasiveness. The fetal bradycardia following cordocentesis is transient and self-limited in most cases, and the prevalence rate of fetal bradycardia following cordocentesis was reported to be between 1.5 and 13 per cent. The purpose of this study was to evaluate the association of fetal heart rate pattern following cordocentesis with adverse pregnancy outcome. METHODS: We investigated retrospectively the fetal heart rate following cordocentesis, the Apgar score of neonate, the birth weight of neonate, gestational age at delivery, preterm delivery, intrauterine growth retardation, stillbirth, and chromosome analysis in 64 codocenteses between 1 February 2000 and 28 February 2001. Normal fetal heart rate was defined as 100 up to 170 bpm, fetal bradycardia as less than 100 bpm lasting one more minute, and fetal tachycardia as more than 170 bpm lasting one more minute. RESULTS: 1. Fetal heart rate pattern following the cordocentesis was normal in 53 cases (82.8%), bradycardia in 6 cases (9.4%) and tachycardia in 5 cases (7.8%). 2. The pregnancy outcome was well-being fetus at birth in 51 cases, terminated pregnancy in 5 cases, intrauterine growth restricted fetus in 5 cases, preterm birth in 1 case and intrauterine death in 2 cases. 3. Mean Apgar-1minute/-5minute scores in neonates were 8.4 +/- 0.2/9.3 +/- 0.2 in the normal fetal heart rate group, 6.8 +/- 1.7/7.6 +/- 1.9 in fetal bradycardia group and 8.4 +/- 0.2/9.4 +/- 0.2 in fetal tachycardia group, that showed no statistically significant difference between groups. 4. The gestational weeks at birth/birth weight were 38.9 +/- 0.4 weeks/3193 +/- 90 g in normal fetal heart rate group, 36.8 +/- 3.2 weeks/2733 +/- 340 g in bradycardia group and 40.0 +/- 0.2/3465 +/- 21 g in tachycardia group, that showed no statistically significant difference between groups. 5. The number of puncture at the same time of cordocentesis was one in 45 cases, two in 15 cases and three in 4 cases. 6. There was no difference in fetal heart rate pattern following cordocentesis between 60 cases of normal and 4 cases of abnormal cardiovascular findings sonographycally. 7. The karyotyping was normal in 60 cases and abnormal in 4 cases, each of which was 46,XY,inv(9),46,X,i(Xq)/45,X,47,XY,+mar, and 46,XX,t(7;15)(q10;q10) respectively. CONCLUSION: Fetal bradycardia or tachycardia following cordocentesis was not associated with adverse pregnancy outcomes.