Screening and Management of Thyroid Dysfunction During Pregnancy

Thyroid hormone is known to play a crucial role in implantation and embryonic development, as well as in the development of the nervous and musculoskeletal systems of fetus. In particular, thyroid dysfunction is associated with various pregnancy-related complications such as miscarriage, preterm birth, fetal growth restriction, and preeclampsia. Previous studies have primarily focus on the adverse effects of hypothyroidism on fetal neurodevelopment. However, the physiological and metabolic alterations occurring during pregnancy in thyroid physiology make it difficult to diagnose thyroid dysfunction. Therefore, obstetricians should have a comprehensive understanding of physiological changes of the thyroid and be familiar with the latest guidelines regarding the complications and management of thyroid dysfunction during pregnancy.

Percutaneous Screw Fixation in a Displaced Pubic Fracture: Technical Note / 대한정형외과학회잡지

Pelvic fractures are high-energy injuries, often accompanied by damage to the adjacent tissues and organs. For patients with pelvic trauma, active treatment is required early in the injury, because mortality can increase if appropriate treatment is not provided. In most cases, however, minimally invasive surgery is considered because extensive surgery cannot be performed due to the patient's condition. Percutaneous fixation of the pubis has been introduced because it can be applied easily to achieve the stability of the anterior part of the pelvis. Although many studies introduced percutaneous fixation of pubic bone fractures, most describe screw fixation for nondisplaced fractures. When treating displaced fractures with percutaneous screw fixation, it is difficult for the guide pin or drill bit to avoid the joint surface. Using a bent guide pin could allow easy insertion of the cannulated screw while avoiding the articular surface.

Dietary pattern and risk of endometrioma in Korean women: a case-control study

Objective@#The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts. @*Methods@#A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher’s exact test for categorical variables. @*Results@#The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold. @*Conclusion@#The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.

Clinical factors that affect the pregnancy rate in frozen-thawed embryo transfer in the freeze-all policy / 영남의대학술지

Background@#This study was conducted to analyze clinical factors that can affect pregnancy rates in normal responders undergoing the freeze-all policy in in vitro fertilization. @*Methods@#We evaluated 153 embryo transfer cycles in 89 infertile women with normal response to controlled ovarian stimulation (COS). After COS, all embryos were cultured to the blastocyst stage, and good quality blastocysts were vitrified for elective frozen-thawed embryo transfer (FET). Clinical variables associated with COS and the results of COS and culture, including the number of retrieved oocytes, fertilized oocytes, and frozen blastocysts were compared between the pregnant group and the non-pregnant group. @*Results@#After a single cycle of COS for each patient, 52 patients became pregnant while 37 did not. Significant differences were observed in the number of matured oocytes, fertilized oocytes, frozen blastocysts, and transferred embryos. The number of frozen blastocysts in the pregnant group was almost twice that in the non-pregnant group (5.6±3.1 vs. 2.8±1.9, p<0.001). The area under the receiver operating characteristic curve for the 4 frozen blastocysts was 0.801 in the pregnant group. @*Conclusion@#In the freeze-all policy, the number of matured oocytes, number of fertilized oocytes, and number of frozen blastocysts might be predictive factors for pregnancy.

Investigation of Maternal Effects, Maternal-Fetal Interactions, and Parent-of-Origin Effects (Imprinting) for Candidate Genes Positioned on Chromosome 18q21, in Probands with Schizophrenia and their First-Degree Relatives

OBJECTIVE: A popular design for the investigation of such effects, including effects of parent-of-origin (imprinting), maternal genotype, and maternal-fetal genotype interactions, is to collect deoxyribonucleic acid (DNA) from affected offspring and their mothers and to compare with an appropriate control sample. We investigate the effects of estimation of maternal, imprinting and interaction effects using multimodal modeling using parents and their offspring with schizophrenia in Korean population. METHODS: We have recruited 27 probands (with schizophrenia) with their parents and siblings whenever possible. We analyzed 20 SNPs of 7 neuronal genes in chromosome 18. We used EMIM analysis program for the estimation of maternal, imprinting and interaction effects using multimodal modeling. RESULTS: Of analyzed 20 single nucleotide polymorphisms (SNPs), significant SNP (rs 2276186) was suggested in EMIM analysis for child genetics effects (p=0.0225438044) and child genetic effects allowing for maternal genetic effects (p=0.0209453210) with very stringent multiple comparison Bonferroni correction. CONCLUSION: Our results are the pilot study for epigenetic study in mental disorder and help to understanding and use of EMIM statistical genetics analysis program with many limitations including small pedigree numbers.

Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy

OBJECTIVES@#To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy.SUMMARY OF LITERATURE REVIEW: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent.@*MATERIALS AND METHODS@#We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final follow-up. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores.@*RESULTS@#The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors.@*CONCLUSIONS@#The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.

Changing Trends in Pregnancy and Childbirth among Women Living with Human Immunodeficiency Virus at a Tertiary Hospital in Korea: A 28-Year Experience / 감염과화학요법

BACKGROUND@#The reports about fertility desire and pregnancy outcome among women infected with human immunodeficiency virus (HIV) in Korea are scarce. This study aimed to determine the changing trend in pregnancy incidence among women infected with HIV in Korea.@*MATERIALS AND METHODS@#We retrospectively reviewed the medical records of women infected with HIV visiting Pusan National University Hospital between January 1990 and October 2018.@*RESULTS@#A total of 149 women with HIV infection visited the study hospital. Among them, 33 pregnancies in 24 (16.1%) women were identified. There were 17 live births (51.5%) and 13 abortions (39.4%), whereas 3 women (9.1%) were transferred to another hospital or were lost to follow-up. The number of live birth rose from 0 in 1990-1998 to 17 in 1999-2018. The proportion of repeated pregnancies after HIV diagnosis also increased steeply, from 14.3% in 1999-2008 to 50% in 2009-2018. However, the number of abortions also increased over time. There were 8 induced abortions, 7 (87.5%) of them were diagnosed with HIV infection during pregnancy and 3 (37.5%) were unplanned pregnancies. Eighteen babies, including 1 twin case, were born from 17 births. There was no mother-to-child HIV transmission in our study.@*CONCLUSION@#The number of pregnancies among women with HIV infection and repeated pregnancies after HIV diagnosis has been increasing in Korea, probably due to the desire of HIV patients to have more children. However, the number of abortions also increased, probably due to health concerns and uncertain pregnancy outcome.

Analysis of Preoperative Factors Affecting Postoperative Spinal Canal Expansion after Posterior Decompression for the Treatment of Multilevel Cervical Myelopathy

STUDY DESIGN: Retrospective analysis OBJECTIVES: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy. SUMMARY OF LITERATURE REVIEW: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent. MATERIALS AND METHODS: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final follow-up. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. RESULTS: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors. CONCLUSIONS: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.

Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture

OBJECTIVE: The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. METHODS: Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. RESULTS: A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance (P=0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r, −0.63; P < 0.01). CONCLUSION: We suggested the use of intradermal buried vertical mattress as a cosmetically superior skin closure method for application in cesarean sections over subcuticular stitch.

1q21.1 microdeletion identified by chromosomal microarray in a newborn with upper airway obstruction

A 1q21.1 microdeletion is an extremely rare chromosomal abnormality that results in phenotypic diversity and incomplete penetrance. Patients with a 1q21.1 microdeletion exhibit neurological-psychiatric problems, microcephaly, epilepsy, facial dysmorphism, cataract, and thrombocytopenia absent radius syndrome. We reported a neonate with confirmed intrauterine growth restriction (IUGR), micrognathia, glossoptosis, upper airway obstruction, facial dysmorphism, and eye abnormality at birth as well as developmental delay at the age of 1 year. These clinical manifestations, except for the IUGR and upper airway obstruction, in the neonate indicated a 1q21.1 microdeletion. Here, we report a rare case of a 1q21.1 microdeletion obtained via paternal inheritance in a newborn with upper airway obstruction caused by glossoptosis and tracheal stenosis.

The effect of tamoxifen therapy on the endometrium and ovarian cyst formation in patients with breast cancer

OBJECTIVE: To evaluate the effect of tamoxifen on female reproductive organs in women with breast cancer. METHODS: We retrospectively reviewed the medical records of 309 women with breast cancer who were currently receiving tamoxifen and undergoing regular gynecological examination. RESULTS: We evaluated 92 pre- and 217 postmenopausal women. The prevalence of endometrial thickening was 12% in the pre- and 10.6% in the postmenopausal group. An endometrial biopsy was performed in 43 women and confirmed endometrial cancer in 1, endometrial polyps in 14, and endometrial hyperplasia in 4 women. Transvaginal ultrasonography showed 25 cases of newly developed ovarian cysts. Most ovarian cysts had disappeared during follow-up. CONCLUSION: Tamoxifen use in women with breast cancer causes few complications and is considered safe for female reproductive organs in case of regular gynecological examination.

The Relationship between Renal Function and Bone Marrow Density in Healthy Korean Women

OBJECTIVES: The relationship between renal function and bone mineral density (BMD) is controversial. We evaluated the relationship between markers of renal function and BMD in healthy Korean women. METHODS: A total of 1,093 women who visited the health promotion center at Pusan National University hospital were included in the cross-sectional study. We divided the study population into two groups by BMD: osteopenia-osteoporosis and normal in the lumbar and femur regions, respectively. We compared the relationship between renal function and BMD using a logistic regression model and used SAS 9.3 (SAS Institute, Inc., Cary, NC, USA) for all statistical analysis. RESULTS: Blood urea nitrogen (BUN), creatinine, and cystatin C (Cys-C) were correlated with BMD in both the normal and osteopenia-osteoporosis groups, and in logistic regression analysis, BUN and Cys-C were correlated with lumbar and femur BMD. However, after we adjusted for age, menopause, and body mass index, only creatinine showed a negative correlation with lumbar BMD, and estimated glomerular filtration rate (eGFR) was related positively with femur BMD. CONCLUSIONS: Serum creatinine could be a marker for lumbar BMD and eGFR for femur BMD in Korean women without overt nephropathy.

Pregnancy-related osteoporosis and spinal fractures

Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.

Crucial role of HMGA1 in the self-renewal and drug resistance of ovarian cancer stem cells

Cancer stem cells are a subpopulation of cancer cells characterized by self-renewal ability, tumorigenesis and drug resistance. The aim of this study was to investigate the role of HMGA1, a chromatin remodeling factor abundantly expressed in many different cancers, in the regulation of cancer stem cells in ovarian cancer. Spheroid-forming cancer stem cells were isolated from A2780, SKOV3 and PA1 ovarian cancer cells by three-dimensional spheroid culture. Elevated expression of HMGA1 was observed in spheroid cells along with increased expression of stemness-related genes, such as SOX2, KLF4, ALDH, ABCB1 and ABCG2. Furthermore, spheroid A2780 cells, compared with adherent cells, showed higher resistance to chemotherapeutic agents such as paclitaxel and doxorubicin. HMGA1 knockdown in spheroid cells reduced the proliferative advantage and spheroid-forming efficiency of the cells and the expression of stemness-related genes. HMGA1 overexpression in adherent A2780 cells increased cancer stem cell properties, including proliferation, spheroid-forming efficiency and the expression of stemness-related genes. In addition, HMGA1 regulated ABCG2 promoter activity through HMGA1-binding sites. Knockdown of HMGA1 in spheroid cells reduced resistance to chemotherapeutic agents, whereas the overexpression of HMGA1 in adherent ovarian cancer cells increased resistance to chemotherapeutic agents in vitro. Furthermore, HMGA1-overexpressing A2780 cells showed a significant survival advantage after chemotherapeutic agent treatment in a xenograft tumorigenicity assay. Together, our results provide novel insights regarding the critical role of HMGA1 in the regulation of the cancer stem cell characteristics of ovarian cancer cells, thus suggesting that HMGA1 may be an important target in the development of therapeutics for ovarian cancer patients.

The association between oxidative stress and bone mineral density according to menopausal status of Korean women

OBJECTIVE: The aim of this study is to investigate the association between oxidative stress and bone mineral density (BMD) according to menopausal status of Korean women. METHODS: A total of 2,232 women who visited to the health promotion center at Pusan National University Hospital between 2010 and 2014 were included in this cross-sectional study. Laboratory tests, such as uric acid, albumin, total bilirubin, which were evaluated as a natural antioxidants. Homocysteine also was evaluated as a factor associated with oxidative stress. Correlation analyses and partial correlation coefficient between BMD scores and laboratory parameters associated with oxidative stress according to menopausal status were performed with Pearson test. RESULTS: By correlation analysis, uric acid had only positive correlation with femur and lumbar BMD in premenopausal and postmenopausal group. But albumin and bilirubin, which were the other natural antioxidants, had no correlation with BMD except total bilirubin with femur BMD in postmenopausal group. Homocysteine had negative correlation with femur BMD in postmenopausal group. But there were different results in partial correlation coefficient adjusted by age and BMI. In premenopausal group, uric acid was still positive correlation with femur and lumbar BMD, whereas in postmenopausal group homocysteine had no correlation with femur BMD, total bilirubin and uric acid had no correlation with lumbar BMD. At the multiple logistic regressions, only age and menopause status, uric acid had correlation with BMD. CONCLUSION: In this study, homocysteine had no correlation with BMD. But in natural antioxidant, uric acid had only positive correlation with BMD.

Vitrification solution without sucrose for cryopreservation in mouse blastocysts / 대한생식의학회지

OBJECTIVE: This study was designed to investigate the survival rate of vitrified mouse blastocysts depending on the presence or absence of sucrose in vitrification solution. METHODS: Mouse two-cell embryos were collected and cultured to blastocysts. Two vitrification solutions were prepared. The control solution was composed of 25% glycerol, 25% ethylene glycol, and 0.5 M sucrose (G25E250.5S) containing 2.5 mL glycerol, 2.5 mL ethylene glycol, 2 mL SSS, and 0.855 g sucrose in 5 mL PB1. The experimental solution was composed of 25% glycerol and 25% ethylene glycol (G25E25) and contained 2.5 mL glycerol and 2.5 mL ethylene glycol in 5 mL PB1. Artificial shrinkage was conducted by aspirating the blastocoelic fluid using an ICSI pipette. To examine the effect of sucrose in the vitrification solution on the survival rate of mouse blastocysts, the shrunken-equilibrated blastocysts were rehydrated or vitrified after being exposed to one of the two vitrification solutions. After exposure and the vitrification-thawing process, the re-expansion rate and hatching rate were evaluated after 6 hours of in vitro culture. RESULTS: The re-expansion rate of mouse blastocysts exposed to vitrification solution with and without sucrose were not different in the experimental solution (without sucrose) (98%) and the control solution (with sucrose) (92%) (p>0.05). The hatching rate was higher in the experimental solution (95%) than in the control solution (88%), but did not differ across two treatments (p>0.05). The re-expansion rate of mouse blastocysts vitrified in the control solution was 92% and 94%, respectively (p>0.05), and the hatching rate was higher in the experimental solution (90%) than in the control solution (74%) (p<0.05). CONCLUSION: Sucrose need not be added in vitrification solution for freezing of artificially shrunken mouse blastocysts.

Adverse effects of 4-tert-octylphenol on the production of oxytocin and hCG in pregnant rats / 한국실험동물학회지

Endocrine-disrupting chemicals (EDCs) are exogenous substances that alter the structure or function of the endocrine system. 4-Tert-octylphenol (OP) is one of the most representative EDCs and has estrogenic effects. In this study, we examined the effects of ethinyl estradiol (EE) and OP on the pituitary gland, placenta, and uterus of pregnant rats. Expression levels of human chorionic gonadotropin (hCG), oxytocin (OT), and contraction-associated proteins (CAPs) were determined, and uterine contractile activity was measured by uterine contraction assay. EE and OP both increased mRNA expression of OT and hCG in the pituitary gland but not the placenta. Since OT and hCG control uterine contraction, we next examined CAP expression in the uterus. Expression of 15-hydroxyprostaglandin-dehydrogenase (PGDH) was upregulated by OP, whereas expression of other CAPs was unaffected. To clarify the effect of OP on uterine contraction in pregnant rats, uterine contraction assay was performed. The 17beta-Estradiol (E2) did not affect contraction of primary uterine cells harvested from pregnant rats in a 3D collagen gel model. However, OP showed different effects from E2 by significantly reducing contraction activity. In summary, we demonstrated that OP interferes with regulation of OT and hCG in the pituitary gland as well as PGDH in the uterus, thereby reducing uterine contraction activity. This result differs from the action of endogenous E2. Collectively, these findings suggest that exposure to EDCs such as OP during pregnancycan reduce uterine contractile ability, which may result in contraction-associated adverse effects such as metratonia, bradytocia, and uterine leiomyomata.

The Association between Serum Uric Acid Level and Incidence of Metabolic Syndrome according to Menopausal Status in Korean Women

OBJECTIVES: The aim of this study is to investigate the association between serum uric acid level and metabolic syndrome according to menopausal status in Korean women. METHODS: A total of 2,241 women who visited to the health promotion center at Pusan National University Hospital from 2010 to 2014 were included in this cross-sectional study. Self-report questionnaires and interviews with healthcare providers were used to assess disease history, medication history, menstrual history and body size measuring. Anthropometric measurements and laboratory results were compared as presence of metabolic syndrome and menopausal status by student-t test. Logistic regression analysis was performed between presence of metabolic syndrome and presumable predictive factors, such as age, menopause and serum uric acid. RESULTS: The prevalence rate of metabolic syndrome were 7.45% (63/846) in pre-menopausal group and 23.87% (333/1395) in menopausal group. Serum uric acid level was higher in menopausal women than premenopausal women (4.6 +/- 1.1 vs. 4.3 +/- 0.9. P = 0.000). And, its concentration was also higher in metabolic syndrome than normal women regarding of menopausal statue (premenopause 4.7 +/- 1.1 vs. 4.2 +/- 0.8, P = 0.001, menopause 4.9 +/- 1.3 vs. 4.5 +/- 1.0, P = 0.000). Multiple logistic regression analysis showed serum uric acid and age have relationship with metabolic syndrome (OR: 1.453, 95% confidence interval [CI]: 1.074-1.111, P = 0.000; OR: 1.092, 95% CI: 1.305-1.619, P = 0.000). CONCLUSION: We could find out some potential of uric acid as predictive factor for metabolic syndrome in premenopausal and menopausal group. Further investigation is required to clarify the relationship between serum uric acid, menopause and metabolic syndrome.

Congenital leukemia of fetus with acquired AML1 gene duplication

Congenital leukemia is very rare, and its prevalence according to recently published papers is from 1 to 5 per million live births. This can be often diagnosed in postpartum throughout bone marrow biopsy, showing abnormal proliferation of immature blasts and granulocytic precursors. Hepatosplenomegaly is the most common feature which is found during perinatal examinations, that diagnosing is difficult during perinatal period. Hepatosplenomegaly can occur not only in congenital leukemia but in many other cases such as infection which is the most common cause. In other words, congenital leukemia is the one of the rare causes of hepatosplenomegaly. However, this case shows the fetus with the features of hepatosplenomegaly during perinatal period and being diagnosed as congenital leukemia associated with acquired AML1 gene duplication in postpartum through bone marrow biopsy. Due to its rare instance, we are to describe the case with a review of literatures.