Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase, Anti-vascular Endothelial Growth Factor and Gas

PURPOSE: To evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas. METHODS: This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed. RESULTS: The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied. CONCLUSIONS: A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.

Selective cyclooxygenase inhibitors increase paclitaxel sensitivity in taxane-resistant ovarian cancer by suppressing P-glycoprotein expression / 부인종양

OBJECTIVE: The purpose of this study was to investigate whether selective cyclooxygenase (COX) inhibitors promote paclitaxel-induced apoptosis in taxane-resistant ovarian cancer cells by suppressing MDR1/P-glycoprotein (P-gp) expression. METHODS: Taxane-resistant ovarian cancer cells were cultured with paclitaxel alone or combined with a selective COX inhibitors. The expression patterns of MDR1/P-gp and the ability of COX inhibitors to inhibit growth of taxane-resistant ovarian cancer cells were measured. The efficacy of prostaglandin E2 (PGE2) supplementation was measured to evaluate the mechanisms involved in suppressing MDR1 gene expression. RESULTS: P-gp was upregulated in taxane-resistant ovarian cancer cells compared to paired paclitaxel-sensitive ovarian cancer cells. An 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay showed that selective COX inhibitors significantly enhanced the cytotoxic effects of paclitaxel in taxane-resistant ovarian cancer cells via a prostaglandin-independent mechanism. These increased apoptotic effects were further verified by measuring an increased percentage of cells in sub-G1 stage using flow cytometry. Selective COX inhibitors suppressed MDR1 and P-gp expression. Moreover, combined treatment with paclitaxel and selective COX inhibitors increased poly (ADP-ribose) polymerase (PARP) cleavage in taxane-resistant ovarian cancer cells. CONCLUSION: Selective COX inhibitors significantly promote paclitaxel-induced cell death in taxane-resistant ovarian cancer cells in a prostaglandin-independent manner. COX inhibitors could be potent therapeutic tools to promote paclitaxel sensitization of taxane-resistant ovarian cancers by suppressing MDR1/P-gp, which is responsible for the efflux of chemotherapeutic agents.

The Volume of Tumor Mass and Visual Field Defect in Patients with Pituitary Macroadenoma

PURPOSE: We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS: We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS: Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS: In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.

A Case of Irritated Seborrheic Keratosis Associated with a Previous Incision Site

An 83-year-old woman had undergone an external dacryocystorhinostomy with silicone intubation. Before the surgery, no skin lesions were observed on the incision site. Three months after surgery, the patient complained of a brown-to-black pigmented elevation at her previous skin incision site. A punch biopsy of the pigmented mass was performed. The histopathologic findings confirmed the clinical diagnosis of irritated seborrheic keratosis (SK). SK can occur several months postoperatively and can suddenly increase in size, so surgeons need to carefully check patients' skin prior to surgery. To our knowledge, this is the first reported case of irritated SK discovered on a previous skin incision site.

Evaluation of apoptosis regulating genes p53, Bcl-2, Bax, and Survivin in uterine cervical cancer tissues during concurrent chemoradiotherapy: Is it possible to identify unresponsiveness to therapy? - A preliminary report / 대한산부인과학회지

OBJECTIVE: The objective of this study is to explore changes of the expression of apoptosis-regulating genes, p53, Bcl-2, Bax, and Survivin in cervical cancer tissues during concurrent chemoradiotherapy (CCRT). METHODS: The expressions of apoptosis-regulating genes were evaluated in 14 patients with invasive squamous cell carcinoma of the cervix, who underwent 6 cycles of CCRT using weekly cisplatin, with immunohistochemical staining and Western blot of p53, Bcl-2, Bax, Survivin. Specimens of the cervical carcinomas were obtained by punch biopsy before starting CCRT and just after 2nd and 4th cycle of weekly cisplatin. We analysed the results with clinicopathological factors of the patients. RESULTS: Among 14 patients, 2 (14.3%) patients did not respond to CCRT. In these 2 cases, p53 and Bax were not expressed before and during therapy, while the expressions of Bcl-2 and Survivin were increased. Complete response and partial response were obtained in 11 cases (78.6%) and 1 case (7.1%), respectively. In this reponse group, Bcl-2 expressiondecreased seriallyduring the treatment, but the expression ofother apoptosis-regulating genes showed no significant change. There was no correlation between the clinicopathological prognostic factors and expressions of p53, Bcl-2, Bax, and Survivin. CONCLUSION: In this preliminary study, we deduced that Bcl-2 expression might predict response of CCRT even before completing treatment. In order to establish this possibility, a large scaled study should be needed in the future.

Effect of operation and chemotherapy on the ovarian function in pre- or perimenarcheal teenage girls with ovarian neoplasm / 대한산부인과학회지

OBJECTIVE: Treatment of ovarian tumor in pre- or perimenarcheal period dramatically improved, so the focus has been shifted to evaluated the reproductive and menstrual function. We checked pre- or perimenarcheal patients with ovarian tumor including malignancy to determine how the treatment affects patient's reproductive and menstrual function. METHODS: Clinical records of 74 pre- or perimenarcheal ovarian tumor managed at Ajou University Hospital from 1994 through 2004, were reviewed. All the patients underwent fertility preserving surgery and chemotherapy was added in some advanced malignant cases. Then we checked menstrual and reproductive status by history and physical exam, endocrine evaluation, pelvic ultrasonography, etc. RESULTS: In 74 evaluable patients, 46 cases (62.2%) were benign, 28 cases (37.8%) were malignant nature. The mean age of the premenarcheal patients at the time of diagnosis was 8.37 years (range, 3.2-14.0 years), and that of the perimenarcheal patients was 13.87 years (range, 11.5-16.9 years). The number of patients with benign tumor was 21 cases (75.0%), and that of malignant tumor was 7 cases (25.0%) in premenarcheal patients, and 25 cases (54.3%) and 21 cases (45.7%) in perimenarcheal patients respectively. The most common diagnosis in 46 cases of benign tumor was mature teratoma which constituted 82.6% (38 cases). Immature teratoma accounted for 8 cases (28.6%) in 14 cases of malignant germ cell tumor. In the patients treated with operation followed by chemotherapy 4 cases (50.0%) were suffered by menstrual problems and follow up data showed the ratio of menstrual problems was increased to 75%, which revealed statistical difference (p<0.05). Only one case (2.6%) in 38 cases of surgery only group experienced menstruation change such as period, duration, dysmenorrhea, and 3 cases (37.5%) in 8 of surgery and chemotherapy group were suffered from menstrual change (p=0.019). None of menstrual changes last permanently. CONCLUSION: After fertility sparing operation with/without adjuvant chemotherapy, majority can anticipate normal menstrual function. Anticancer treatment especially chemotherapy can affect ovarian function but it may be transient. This information is expected to prove helpful in the future counselling of such patients.

Prognostic factors in recurrent cervical cancer patients with pulmonary metastasis / 대한산부인과학회지

OBJECTIVE: To characterize prognostic factors in patients with pulmonary metastasis in recurrent cervical cancer. METHODS: The records of 2,042 patients treated for cervical cancer from 1994 to 2004 at two institutions were retrospectively reviewed. Twenty-five (1.04%) patients had pulmonary lesions consistent with metastatic cervical cancer. The data were analyzed retrospectively and reviewed for patient characteristics. RESULTS: Patients were treated with chemotherapy, radiotherapy only, chemoradiotherapy, surgery, and conservative treatment. There were no significant differences in survival rates between each treatment method (p=0.3410). Mean survival after treatment of pulmonary metestasis was 23 months. Histologic type, lymph node metastasis, other organ metastasis, and pretreatment SCC level were not significant prognostic factors, but FIGO stage (p=0.039) and disease-free interval (p=0.033) were significant factors. CONCLUSION: This study revealed that FIGO stage and disease-free interval were independent prognostic factors of pulmonary metestasis in recurrent cervical cancer.

Factors influencing quality of life of cervical cancer patients in Korea / 대한산부인과학회지

OBJECTIVE: To assess the quality of life (QOL) of uterine cervical cancer patients after treatment in Korea and to demonstrate influencing factors. METHODS: 127 uterine cancer survivors, 107 controls of benign gynecologic surgery patients were interviewed with study questionnaire by research assistant. RESULTS: Participants were with the mean age of 54 years (cancer patients) and 43 years (controls). Physical component score of General QOL was statistically significant in uterine cervical cancer group compared with control group (p=0.049). Parts of MCS, CS-QOL, Emotional support, Coping efforts didn't show differences between two groups. In patients' characteristics, high economic status and advanced stage influenced patient's adaptation to treatment. When evaluating QOL including sexual function, most parts were statistically significantly worsen in uterine cancer patients, ie, sexual dysfunction (p=0.004), sexual discomfort (p=0.070), sexual pleasure (p=0.011), gynecological symptom (p=0.001). Most factors except age didn't influence sexual function deterioration between cancer group and control group. Common presenting concerns of cancer patients before treatment was health (51%), children (23%), economic problem (16%) but after treatment health (92%). The most helpful people were family members in 84% and physicians in 9%. CONCLUSION: Uterine cervical cancer survivors in Korea appear to experience greater distress on sexual function especially in young age. Therefore it is important for health care professionals to recognize that aspects of cancer survivorship continue to require education and adequate follow-up program.

A case of malignant mesothelioma of the uterus / 부인종양

Malignant mesothelioma of the uterus is a rare mesenchymal neoplasm originating from the mesothelial surface cell lining of the uterus. It is known to have very poor prognosis with median survival period of 4-18 months. We report a rare case of primary malignant mesothelioma of the uterus showing no evidence of recurrence for 2 years, after management with operation and adjuvant chemotherapy.

A case of malignant mesothelioma of the uterus / 부인종양

Malignant mesothelioma of the uterus is a rare mesenchymal neoplasm originating from the mesothelial surface cell lining of the uterus. It is known to have very poor prognosis with median survival period of 4-18 months. We report a rare case of primary malignant mesothelioma of the uterus showing no evidence of recurrence for 2 years, after management with operation and adjuvant chemotherapy.

One case of primary malignant mixed Mullerian tumor of the pelvic peritoneum / 부인종양

Malignant mixed mullerian tumor (MMMT) is a tumor in which carcinoma (an epithelial malignancy) is mixed with sarcoma (a nonepithelial malignancy). Extrauterine MMMTs are extremely rare, and only 32 cases are reported according to the literature. We experienced a case of primary peritoneal MMMT and repot with a brief review of literature.

The association of the cervical intraepithelial neoplasia and human papillomavirus viral load / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine the relationship between the cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) DNA load and to evaluate the efficacy of viral load in prediction of histologic severity. METHODS: The cervical cytology and Hybrid Capture II tests for HPV detection were performed in 2411 women visited our hospital, from August 2003 to October 2004. A total of 259 consecutive women underwent cervical colposcopy directed biopsy and operations with confirmed final histologic diagnoses were included. Viral load was measured by Hybrid Capture II system expressed as relative lights unit (RLU) ratio of specimens and controls. RESULTS: There was no significant difference of CIN 1, CIN 2, CIN 3, SCC group and control group in the clinical characteristics. The higher the viral load, the higher stage of CIN was shown. HPV viral load test showed sensitivity of 82.9%, specificity of 37.7%, positive predictability of 60.0%, negative predictability of 66.2% in detecting CIN, while 94.4%, 34.3%, 67.5%, 80.8% in detecting HGSIL. The viral loads were categorized into four groups (negative, low, intermediate, high) for analysis and it was shown that higher viral load group tended to exist CIN more frequently (odds ratio=1, 1.8, 3.4, 3.5). In addition, viral load was more strongly associated with the risk of HGSIL than that of LGSIL (odds ratio=1, 6.7, 9.0, 9.6). CONCLUSION: We found that the higher HPV viral load is significantly associated with the higher stage of CIN. The measurement of HPV DNA load is useful for predicting the severity of lesions of the uterine cervix and making decision of treatment plans.

A case of primary transitional cell carcinoma of the fallopian tube / 대한산부인과학회지

Primary carcinoma of the fallopian tube is a rare entity that accounts for about 1% of all gynecologic malignancies, and most are discovered during or after surgery. Primary transitional cell carcinoma of the fallopian tube is an extremely rare tumor that is reported only occasionally in the worldwide literature. Histologically, fallopian tube carcinomas are almost always papillary adenocarcinomas, but other histologic types such as endometrioid carcinoma, clear cell carcinoma, and mixed carcinoma have been reported. As primary transitional cell carcinoma (TCC) of the fallopian tube is so rare, the clinicopathologic characteristics are as yet unknown. The authors recently experienced a case of primary transitional cell carcinoma arising in the fallopian tube, and thus report the clinical features, management, and also a review of the past pertinent literature.

A case of term delivery in a woman with didelphic uterus after expelling the decidual cast at midtrimester: Case report / 대한산부인과학회지

The passage of decidual cast in pregnancy is rare and mostly associated with some kind of congenital uterine malformation. Since the hemorrhage caused by the passage of decidual cast can easily be mistaken for other causes of the antepartum hemorrhge, it often leads to the premature delivery of the baby which results poor perinatal outcome. Moreover it mostly happened nonpregnant horn in didelphic or bicornuate uterus, although decidual cast was expelled. We have experienced a case of woman with didelphic uterus and past history of two consecutive premature deliveries, who delivered a female baby at 38 gestational weeks through intensive care after expelling decidual cast in pregnant uterus at 30 gestational weeks. We present this case with a brief review of literatures.

Neoadjuvant chemotherapy in cervical carcinoma during pregnancy: Case report / 부인종양

When the cervical cancer is diagnosed in early stage during pregnancy, the treatment can be postponed for fetal viability. This case presents a patient diagnosed as cervical cancer stage Ib1 during her pregnancy. The patient had 2 cycles of neoadjuvant chemotherapy (Paclitaxel-cisplatin) formerly and cesarean section was done at 33rd weeks of intrauterine pregnancy, then radical abdominal hysterectomy with bilateral pelvic lymph node dissection and paraaortic lymph node biopsy was immediately performed right after the delivery. For the baby born, there was neither complication nor congenital anomaly but mild bilateral ventriculomegaly seen on brain CT taken on 3 days after birth. This case offers a better chance for both mother and fetus while conserving fetal viability and managing the early cervical cancer during pregnancy through close follow up.

The Effect of Hormone Replacement Therapy on Osteoporosis Following Irradiation of Gynecologic Cancer Patients / 부인종양

OBJECTIVE: This article is based on gynecologic cancer patients who were treated with radiation-therapy. The postmenopausal symptoms and osteporotic change and it's deterioration before and after these treatments were investigated. We represent the effect of appropriate medication for these patients. METHODS: Patients who were diagnosed as cervical cancer, endometrial cancer and ovarian cancer and hospitalized for their treatment in department of gynecology in Ajou Medical Center were selected. Before the treatment, Kupperman's index and bone mineral density of lumbar spine were checked. After the treatment, we divided the patients into 2 groups; a group of patients who were medicated with premarin, tibolone and raloxifen and a control group who were non-medicated. And these groups were reexamined Kupperman's index and bone mineral density of lumbar spine. And then effect on radiation-therapy and result of hormone therapy were analyzed. RESULTS: This study was based on total 63 patients; 47 (74.6%) patients were medicated and 16 (25.4%) patients were not medicated, for hormone therapy used. The average age of patients was 49.6 years old for medicated and 51.2 years old for non-medicated showing no significant differences. The mean period of medication of was 6-30 months. Comparing one group who's treated with radiation-therapy to the other group who's not treated with radiaton-therapy, decrease in BMD and T-score was noted, but statistically not significant (p=0.309, p=0.107). Comparing hormone treated group to control group, the BMD after medication was from 0.89 g/cm2 to 0.91 g/cm2, that of T-score was -1.48 from -1.68, and for the control group, BMD was from 0.91 g/cm2 to 0.96 g/cm2 and that of T-score was from -1.16 to -1.53. This indicates that osteoporotic change was turning in favor in hormone treated group. Especially, for the menopausal women who were treated with radiation-therapy, hormone replacement therapy was proved to be effective. In addition, medicated and non-medicated group showed significant difference in Kupperman's index which account for change in postmenopausal symptom. DISCUSSION: Gynecologic cancer generally occurs in 40-50 years at times when postmenopausal symptom and osteoporotic change begin to appear. In case of patients who're treated with radiation-therapy, this phenomenon is likely to happen much faster. Nowadays, as the average life expectancy becomes longer owing to development of cancer therapy, we suggest a method which improves quality of life, that is taking osteoporosis exam at regular interval and appropriate hormone therapy when needed after radiation-therapy.

Relationship between Pre-treatment Serum SCC (squamous cell carcinoma) Antigen, Cyfra 21-1 Levels, and Survival in Squamous Cell Carcinoma of the Uterine Cervix / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To determine the relationship between pretreatment serum squamous cell carcinoma (SCC) antigen and Cyfra 21-1 levels, and survival in patients with invasive squamous cell carcinoma of the cervix. MATERIALS AND METHODS: One hundred and one cervical squamous cell carcinoma patients were included. Pre-treatment levels of serum SCC antigen and Cyfra 21-1 were measured, with a 5 year minimum follow up. Thirty two recurrent disease (RD) patients were compared to 99 non-recurrent disease (NRD) patients with respect to tumor markers, FIGO stage, lesion size, lymph node status, and parametrial involvement. RESULTS: Pre-treatment serum SCC antigen and Cyfra 21-1 levels were significantly higher in the RD group (p<0.001). Combined serum SCC antigen and Cyfra 21-1 levels showed higher sensitivity for prediction of recurrence (90.6%). Pre-treatment SCC antigen and Cyfra 21-1 levels showed correlation with high FIGO stage, large lesion size, lymph node status, and parametrial involvement (p<0.001). Normal pre-treatment levels of SCC antigen and Cyfra 21-1 showed a 5-year survival rate of 93% and 90% respectively, while elevated levels showed significantly decreased survival rate of 63% and 59%, respectively (p<0.001). Odd ratio for cumulative survival rates were 6.87 for SCC antigen, and 5.07 for Cyfra 21-1 (p<0.001). CONCLUSIONS: Initial pre-treatment levels of serum SCC antigen and Cyfra 21-1 are closely related to FIGO stage, lesion size, lymph node and parametrial involvement in patients with squamous cell carcinoma of the cervix. Also, these markers may be of help to predicting recurrent disease and survival rates.

A Case of Ovarian Steroid Cell Tumor with Obesity / 대한산부인과학회잡지

Ovarian steroid cell tumors are composed exclusively of cells that have the histologic features of steroid hormone secreting cells. And these are rare lesions and have been divided into four subtyes according to their size, location in the ovary, and presence or absence of crystals of Reinke in the cytoplasm as follows: stromal luteomas, hilus cell tumors, Leydig cell tumors (non-hilar type), and steroid cell tumors not otherwise specified. Steroid cell tumors often secret androgens, and manifest themselves with symptoms of virilization. Other presenting manifestations include hirsutism, amenorrhea, obesity, hypertension and alopecia. We experienced a case of ovarian steroid cell tumor, manifested by obesity and amenorrhea and present with a brief review of the literatures.

Comparison of Efficacy between MonoPrep(R) and Papanicolaou Smear for Cervical Cancer Screening / 대한산부인과학회잡지

OBJECTIVE: To compare the specimen adequacy and cytologic diagnostic results of MonoPrep(R), a type of liquid based preparation, with the conventional Pap smear. METHODS: In randomly selected 156 patients who visited the department of Obstetrics and Gynecology, Ajou University Hospital for cervical biopsy, conventional Pap smear and matched MonoPrep(R) were performed. Statistical analysis was performed with chi-square test. RESULTS: There were more "Unsatisfactory" and "Satisfactory but limited by (SBLB)" results in the conventional Pap smear group, even though no statistical significance could be found between the two groups. ASC/LSIL ratio was significantly decreased in the MonoPrep(R) group, showing 0.4 with MonoPrep(R) and 1.9 with conventional Pap smear demonstrating a 78.4% decrease (P<0.001). In detecting abnormal cervical lesions, conventional pap smear showed a sensitivity of 87.7%, positive predictability of 82.3%, false negativity of 10.3%, while MonoPrep(R) showed a sensitivity of 94.8% (P=0.04), positive predictability of 97.4% (P<0.001), and false negativity of 2.6% (P=0.016). CONCLUSION: MonoPrep(R) is more effective for the detection of cervical lesions with higher sensitivity and lower false negativity compared to conventional pap smear.

A Case Study of Death by Bullet with Fired Blank Cartridge / 대한법의학회지

An university student passed away by an unidentified bullet in a reserve force exercise. An X-ray could not find any bullet from the thorax. The post-mortem examination revealed that the victim had been killed by a 5.56 mm (diameter) bullet. The striation mark of the fatal bullet was coincided with a test fired bullet of a suspect's machine gun. However only blank cartridges had been fired according to the firing range records. Also, the examiner found that the mouth diameter of the fatal blank cartridge case is narrower than the others. In order to explain the strange happening, various situation of blank cartridge firing was considered. The examiner group noticed that the diameter of a blank cartridge mouth fired from an unexpelled bullet including gun may change. The authors test fired a blank cartridge case with a gun including an unexpelled bullet, and compared the shape of the mouth with the fatal blank cartridge case. The mouth shapes of two blank cartridges were coincided. The authors could conclude that the an unidentified suspect charged a bullet in the muzzle of the suspect's gun, and the bullet expelled by the gas pressure of the fatal blank cartridge case.