Erratum to: Ezrin Is an Essential Marker for Metastasis of Gynecologic Cancer

Author's list and affiliation correction.

Is Complementary and Alternative Therapy Effective for Women in the Climacteric Period?

Vasomotor symptoms start about 2 years prior to menopause in women who are approaching menopause, and early menopause symptoms appear including emotional disturbance and anxiety, followed by physical changes such as vaginal dryness, urinary incontinence and skin wrinkles. As time progresses, osteoporosis, cardiovascular diseases, and dementia occur consecutively. Hormone therapy is primarily considered for the relief of menopause symptoms in postmenopausal women. However, as hormone replacement has emerged as a therapy that increases the potential risk of thrombosis, cerebral infarction and breast cancer, complementary and alternative medicine has drawn much attention. This study aimed to examine the types and effects of evidence-based complementary and alternative therapies that are currently used.

An Ethical Issue in Medical Education of Obstetrics and Gynecology

There are four principles of medical ethics; Beneficence, Respect for autonomy, Non-maleficence, and Justice. It is not easy to apply to principles of medical ethics in the special circumstances of obstetrics and gynecology. Student doctors must learn to be familiar with principles of medical ethics tailored to the special circumstances while the obstetrics and gynecology practice.

Uterine Serous Adenocarcinoma in an Elderly Postmenopausal Woman: Clinically Misdiagnosed as Uterine Cervix Cancer

Uterine serous adenocarcinoma (USC) is rare and invasive cancer. This cancer is more often reported in the ovary, the fallopian tube, and the endometrium than uterine cervix. No matter where the tumor is located, the tumor exhibits similar histological characteristics. So when uterine cancer is proven to be serous adenocarcinoma, it is necessary to see if the tumor originated from ovary or endometrium and invaded the cervix. We report a case of a 73-year-old postmenopausal woman with USC arising near the internal os of endocervical canal, clinically misdiagnosed as uterine cervix cancer.

Expression of Vitamin D Receptor in Seminal Vesicles of Cholesterol Formula Mice

OBJECTIVES: Genomic function of vitamin D receptor (VDR) indicates spermatogenesis that is important for in male reproductive organ authors evaluated the VDR expression in seminal vesicles with high cholesterol (HC) formula diet rat, because there is no report about relationship or difference in VDR in seminal vesicles between HC and control. METHODS: Male C57BL/6 mice aged 5 weeks were raised for 13 weeks. After one week of adaptation-period, they were fed different diet on normal AIN-93G diet, or HC diet containing 2% cholesterol for 12 weeks. The antibodies used were rabbit anti-VDR primary polyclonal. RESULTS: There was no significant difference in VDR reactivity in seminal vesicles, body weight of rat and weight of seminal vesicles between HC group and normal control group. CONCLUSION: Our data give the no difference in expression of VDR of seminal vesicles rat between HC formula diet and normal AIN-93G diet. But we confirmed the VDR expression in seminal vesicles.

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis.

Ezrin is an Essential Marker for Metastasis of Gynecologic Cancer / 대한폐경학회지

Ezrin, a membrane cytoskeleton linking protein, is a member of ezrin/radixin/moesin (ERM) that regulates cell shape, motility and cell to cell interaction via linking the contractile elements of the cell to transmembrane proteins. Ezrin, through this mechanism, has been thought to play an important role in cancer progression and distant metastasis. In addition, high levels of ezrin expression have been noted in many cancers, such as breast, colon, osteosarcoma, and prostate cancer. Gynecologic cancer cells, with high levels of ezrin expression, have more invasive potential than that of the lower levels of ezrin expressed cancer cells. High levels of ezrin expression are also related to the advanced histological grade and poor outcome. Recently, several reports have also demonstrated that ezrin expression is enhanced and almost localized at the membranous portion in high stage tumor cells and metastatic gynecologic cancer cells. Therefore, in the near future, ezrin levels and its cellular location might serve as essential markers for the metastasis of gynecologic cancers.

Menopausal Hormone Treatment and the Progression of Vascular Disease / 대한폐경학회지

Observational studies and laboratory research support cardioprotective effects of menopausal hormone treatment (MHT). However, cardioprotective effects of MHT were not confirmed by randomized clinical studies that were made up of subjects who were well-beyond the time of menopausal symptoms and were of advanced chronological age when they began hormone treatment (HT). The differences in study outcomes most likely reflect age-related differences in cardiovascular risk factors such as hypertension and metabolic syndromes. As well, data from the randomized clinical trial (RCT)s confirmed the presence of actual cardiovascular disease (CVD) in many of the RCT subjects prior to beginning HT. Therefore, beginning MHT early seems crucial since older women are at greater risk for the presence of risk factors and sub-clinical CVD. Older women also are possible targets of hormonally related thrombosis because of their underlying vascular disease. The need for early prophylaxis is convenient since most women seek treatment for symptoms within the first few years of menopause. This review addresses issues regarding optimization of the initiation of MHT for cardioprotection.

Menopausal Hormone Treatment and the Progression of Vascular Disease / 대한폐경학회지

Observational studies and laboratory research support cardioprotective effects of menopausal hormone treatment (MHT). However, cardioprotective effects of MHT were not confirmed by randomized clinical studies that were made up of subjects who were well-beyond the time of menopausal symptoms and were of advanced chronological age when they began hormone treatment (HT). The differences in study outcomes most likely reflect age-related differences in cardiovascular risk factors such as hypertension and metabolic syndromes. As well, data from the randomized clinical trial (RCT)s confirmed the presence of actual cardiovascular disease (CVD) in many of the RCT subjects prior to beginning HT. Therefore, beginning MHT early seems crucial since older women are at greater risk for the presence of risk factors and sub-clinical CVD. Older women also are possible targets of hormonally related thrombosis because of their underlying vascular disease. The need for early prophylaxis is convenient since most women seek treatment for symptoms within the first few years of menopause. This review addresses issues regarding optimization of the initiation of MHT for cardioprotection.

Acute renal failure associated with ureteral stone of the unilateral kidney and uterus didelphys with hemivaginal obstruction / 대한산부인과학회지

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.

Cornual pregnancy diagnosed at 9 weeks of atypical ultrasonographic findings / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

A case of hemoperitoneum to spontaneous perforation of uterine leiomyoma with huge cystic degeneration / 대한산부인과학회지

Uterine leiomyoma is common benign tumor in reproductive age woman. And secondary degeneration of uterine leiomyoma can be occurred usually during midpregnancy and the puerperium. But, spontaneous perforation of uterine leiomyoma with cystic degeneration is very rare. We have experienced a case of spontaneous perforation of a huge cystic degenerative uterine leiomyoma associated with massive hemoperitoneum in a menopausal woman, and report it with a brief review of literature.

A case of treatment of peritoneal trophoblastic tissue implants after laparoscopic salpingectomy / 대한산부인과학회지

The incidence of ectopic pregnancy has increased considerably a decade. And treatment has changed from salpingectomy by laparotomy to conservative laparoscopic surgery or medical treatment. This procedure has many advantages, but there are also disadvantages with the conservative approach and several studies have reported a higher incidence of residual trophoblastic tissue remaining in the tube after treatment. Postoperative follow up of human chorionic gonadotropin (hCG) levels and ultrasonography are needed. This report describes a rare case of persistent trophoblastic implants to the ovary and peritoneum 40 days after laparoscopic salpingectomy. Treatment consisted of laparoscopic excision with biopsy forceps and bipolar, followed by medical treatments. So we report with a brief review of literatures.

Two cases of complete chorioamniotic membrane separation / 대한산부인과학회지

As chorion and amnion fusion usually occurs between 14 and 16 weeks of gestation, sonographic identification of chorion and amniotic membrane separation is a normal finding before 14 weeks. However, persistent separation after 16 weeks of gestation is considered rare and abnormal findings. Complete chorioamniotic membrane separation (CMS) may occur spontaneously, but has also been described as a complication of all invasive intrauterine procedures, including amniocentesis. Complete CMS have a significant morbidity and mortality due to intrauterine fetal death, cord complications, and preterm delivery. Aggressive treatment with hospitalization is necessary. We now report 2 cases of complete CMS identified by prenatal ultrasound; 1 in spontaneous complete CMS diagnosed at 24 weeks of gestation, and health premature child was born at 29+3 weeks of gestation, who was alive and well at present; 1 in complete CMS diagnosed at 21 weeks of gestation after amniocentesis, and fetal demise at 24 weeks of gestation due to cord strangulation by an amniotic band. We experienced two cases of complete CMS and report with a brief review of literatures.

Uterine prolapse complicating pregnancy / 대한산부인과학회지

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.

Spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy / 대한산부인과학회지

Ectopic pregnancy and appendicitis in pregnancy are two most common causes of acute abdomen in young women and differenciation of these diseases is very difficult. Heterotopic pregnancy is a rare event, occuring less than 1:30,000 pregnancies in natural conception cycles. However, with assisted reproduction techniques, this incidence has increased. We experienced a case of spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy. So we report this case with brief review of literature.

A case of cesarean scar ectopic pregnancy / 대한산부인과학회지

Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Surgical management can be safe and effective and medical treatment can be selected as appropriate selection criteria. Patients with history of a pregnancy in a cesarean delivery scar should be advised of the risk for future uterine rupture and placenta accreta. We experienced a case of ectopic pregnancy with treatment of surgical excision and report with a brief review of literatures.

A study on the expression of p16 gene, methylation of p16 gene promoter and HPV typing in uterine cervical neoplasia / 부인종양

OBJECTIVE: p16 is cyclin-dependent kinase (CDK) inhibitor which decelerates cell cycle by inactivating CDKs that phosphorylate retinoblastoma protein (pRb). In cervical carcinogenesis, abnormality of p16 gene such as methylation of p16 gene promoter was investigated as an important factor. The aims of our study are to investigate the expression of p16 gene, methylation of p16 gene promoter region, and HPV typing in uterine cervical neoplasia. METHODS: A total of 104 samples (CIN1, 30 CIN2,3 45, invasive cancer, 29) were included. Expression of p16 was analyzed by immunohistochemistry, methylation of p16 gene promoter region was analyzed with methylation specific polymerase chain reaction (MSP) and we examed the result of HPV DNA testing. RESULTS: 1. In high risk HPV and low risk or negative group, p16 gene expression was observed in CIN1 (30% vs 23%), CIN2, 3 (64% vs 58%) and in invasive cancer (80% vs 37%) respectively. In invasive cancer, p16 gene expression of high risk HPV group was statistically higher than that of low risk or negative group. 2. In high risk HPV and low risk or negative group, p16 promoter methylation was observed in CIN1 (23% vs 17%), CIN2, 3 (25% vs 47%) and in invasive cancer (19% vs 87%) respectively. In invasive cancer, p16 promoter methylation of low risk or negative HPV group was statistically higher than that of low risk or negative group. CONCLUSION: p16 gene expression would be marker for CIN and cancer. Methylation of p16 promoter region may be one of the important mechanism for uterine cervical carcinogenesis especially in negative or low risk HPV group. but further studies are needed to reinforce this statement.

The usefulness of ovarian volume using 3D VOCAL transvaginal ultrasound, antral follicle count and age as predictors of menopause in pre- and postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the sensitivity and specificity of ovarian volume using 3D VOCAL and 2D ultrasound, antral follicle count, and age as predictors of menopausal status in pre- and postmenopausal women. METHODS: The subjects of this study were premenopausal (n=38) and postmenopausal (n=23) healthy women aged between 35 and 57 years of age who were interviewed about social, demographic, and medical conditions. These women underwent transvaginal ultrasound using 3D VOCAL and 2D probe to determine ovarian volume. Chi-square test was applied to evaluate the correlation between ovarian volume, antral follicle count, age and menopausal status. Receiver operating Characteristic (ROC) curves were elaborated to evaluate the sensitivity, specificity and positive and negative predictive values. RESULTS: Premenopausal women presented larger ovaries than postmenopausal women (p<0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p<0.01). ROC curves showed that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe were more sensitive and specific markers of menopausal status than age or ovarian volume using 2D transvaginal probe. CONCLUSIONS: Ovarian volume and antral follicle count differ according to age in pre- and postmenopausal women. The data suggest that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe are quite useful in predicting menopausal status.