A Case of Malignant Mixed Mullerian Tumor of Uterus after Tamoxifen Therapy for Breast Cancer / 대한산부인과학회잡지

Tamoxifen is widely used for the treatment of breast cancer and currently proposed for preventive strategies. However. there is evidence that tamoxifen may affect other hormone sensitive organs, such as uterus and ovary. It has been documented that tamoxifen treatment is associated with development of endometrial polyp, endometrial hyperplasia, ovarian and endometrial cancer. Uterine malignant mixed mullerian tumor is a neoplasm which apparently arises from undifferentiated mullerian stroma and is composed of a mixture of malignant epithelial and stromal component. We report a case of malignant mixed mullerian tumor of uterus which was developed in a patient treated with tamoxifen for 5 years following a modified radical mastectomy due to breast cancer.

The Comparison of Pregnant and Non-pregnant Women for Homocysteine, Vitamin B12 Levels and the Study of Factors Effecting on Homocysteine, Vitamin B12 / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare with pregnant and non-pregnant women for homocysteine and vitamin B12 and to determine effecting factors on serum homocysteine and vitamin B12 level. METHODS: From March 2001 to February 2002, 202 pregnant (24-28 wks) women and 237 non- pregnant women were included in this study. Blood sample for homocysteine, vitamin B12, folate and questionaires about life style and nutrition were done. Homocysteine was measured by HPLC and vitamin B12, folate were measured by RIA. RESULT: Concentrations (mean+/-8D) of homocysteine and vitamin B12 in pregnant women were 8.2+/-3.1 micromol/L, 449.4+/-212.3 pg/ml, and in non-pregnant women were 12.5+/-6.3 micromol/L, 1017.1+/-296.8 pg/ml, respectively. Risk group of homocysteine was 6.5% in pregnant women (n=12/185), and 26.4% in non- pregnant women (n=57/216). In pregnant women, homocysteine have a negative correlation with folate, vitamin B12 (p<0.05). Non- pregnant women were divided to three groups (smoker, ever been smoker but stop smoking now, non- smoker) and concentrations of homocysteine were 13.6+/-7.0, 13.0+/-6.7, 11.9+/-7.6 micromol/L, respectively. They were divided to two groups (drinker, non-drinker) and concentrations of homocysteine were 12.9+/-7.0, 10.4+/-3.0 micromol/L respectively (p<0.05). Pregnant women who take nutrients have a higher concentration of folate than in women do not (8.8+/-5.1 vs. 7.9+/-3.9 pg/ml, p<0.05). CONCLUSION: Homocysteine in women during pregnancy is decreased by about 35% compared with that of non-pregnant women. In pregnant women, as homocysteine increases, as folate and vitamin B12 decrease. Among the non-pregnant women, higher level of homocysteine demonstrated in smokers than in non-smokers and in drinkers than non-drinkers. In pregnant women who take nutrients have a significant higher level of folate than do not, but have no significant relationship in homocysteine level.

The Clinical Significance of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in Pretreatment Evaluation of Invasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: This study aimed to evaluate the clinical significance of CT or MRI in detecting parametrial invasion, pelvic or para-aortic lymph node metastasis. We also evaluated whether IVP, cystoscopy and sigmoiodoscopy could be replaced by CT or MRI. METHODS: The medical records of 130 patients with invasive cervical cancer who were histologically diagnosed from Jan 1994 to Feb 1999 at MokDong Hospital were reviewed. We compared the results of physical examination, CT or MRI, and surgical finding in detecting the prarmetiral invasion and pelvic or para-aortic LN metastasis. We also compared the results of IVP, cystoscopy, sigmoidoscopy with the finding of CT or MRI. Fishers exact test was used and p<0.05 was regarded as statistically significant. RESULTS: CT or MRI were clinically significant in detecting parametrial invasion, pelvic or para-aortic LN metastasis, ureter, bladder and rectosigmoid invasion (p<0.005). In detecting parametrial invasion and pelvic or para-aortic LN metastasis, the positive predictive value of CT or MRI were 33.3%, 70% and the negative predictive value were 98%, 91.5%, respectively. In detecting ureter, bladder, and rectosigmoid invasion, the positive predictive value of CT or MRI were 62.5%, 26% and 17% and the negative predictive value were 98%, 100% and 100%, respectively. CONCLUSION: CT or MRI can provide useful information as to parametrial invasion and pelvic or para- aortic lymph node metastasis. CT or MRI can substitude for IVP, cystoscopy, sigmoidoscopy. And only if bladder and rectosigmoid invasion is suspected on MRI, we must perform cystoscopy and sigmoidoscopy to confirm the invasion. Because CT is either superior or equal to IVP in evaluation of the urinary tract, it is not necessary to perform IVP when CT is performed.

Comparing the Efficiency of 75 gm Oral Glucose Tolerance Test to 100 gm Oral Glucose Tolerance Test in Diagnosing Gestational Diabetes in Korean Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.

Comparing the Efficiency of 75 gm Oral Glucose Tolerance Test to 100 gm Oral Glucose Tolerance Test in Diagnosing Gestational Diabetes in Korean Women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare one-step 2 hour 75 gm oral glucose tolerance test (OGTT) proposed by the World Health Organization (WHO) with two-step 3 hour 100 gm OGTT of National Diabetes Data group (NDDG) criteria for determining gestational diabetes. METHODS: Data for 111 pregnant Korean women who were diagnosed of gestational diabetes either by 75 gm OGTT or 100 gm OGTT and 100 normal controls were reviewed and analyzed retrospectively. The effectiveness of the two tests was determined by comparing the frequency of diabetes-related pregnance outcomes such as macrosomia, cesarean delivery, and preterm birth. Chi-square, Fisher's Exact test, and T-tests were used for statistical analysis. RESULTS: Among 111 gestational diabetic women, 59 (53.2%) were diagnosed by WHO criteria of 75 gm OGTT and 52 (46.8%) were diagnosed by 100 gm OGTT of NDDG criteria. Frequency of macrosomia and cesarean section was higher in 75 gm test group than in 100 gm test group (12.3% vs 5.8% and 35.1% vs 21.2%, respectively), but the difference was statistically not significant. When compared to the control group, 75 gm test group reached statistical significance in having higher incidence of macrosomia (12.3% vs 3%, p<0.05) whereas 100gm test group did not. CONCLUSION: Efficacy of the diagnostic criteria of WHO was comparable to that of NDDG for diagnosing gestational diabetes. This suggests WHO's 75 gm OGTT to be an efficient diagnostic tool for gestational diabetes in Korean women.