Suppression of ARID1A associated with decreased CD8 T cells improves cell survival of ovarian clear cell carcinoma / 부인종양

Objective@#AT-rich interactive domain 1A (ARID1A) plays an important role as a tumor suppressor gene in ovarian clear cell carcinoma (OCCC), but the clinical application of ARID1A remains unclear. The aim of this study was to analyze clinicopathological parameters, molecular interactions and immune-infiltration in patients with low ARID1A expression and to provide candidate target drugs. @*Methods@#We investigated the clinicopathologic parameters, specific gene sets/genes, and immunological relevance according to ARID1A expression in 998 OCCC patients from 12 eligible studies (using meta-analyses); 30 OCCC patients from the Hanyang University Guri Hospital (HYGH) cohort; and 52 OCCC patients from gene set enrichment (GSE) 65986 (25 patients), 63885 (9 patients), and 54809 (6 patients and 12 healthy people) of the Gene Expression Omnibus (GEO). We analyzed network-based pathways based on gene set enrichment analysis (GSEA) and performed in vitro drug screening. @*Results@#Low ARID1A expression was associated with poor survival in OCCC from the metaanalysis, HYGH cohort and GEO data. In GSEA, low ARID1A expression was related to the tumor invasion process as well as a low immune-infiltration. In silico cytometry showed that CD8 T cells were decreased with low ARID1A expression. In pathway analysis, ARID1A was associated with angiogenic endothelial cell signaling. In vitro drug screening revealed that cabozantinib and bicalutamide effectively inhibited specific hub genes, such as vascular endothelial growth factor-A and androgen receptor, in OCCC cells with low ARID1A expression. @*Conclusions@#Therapeutic strategies making use of low ARID1A could contribute to better clinical management/research for patients with OCCC.

Is preeclampsia itself a risk factor for the development of metabolic syndrome after delivery?

OBJECTIVE: This study aimed to determine the association between preeclampsia and the postpartum development of metabolic syndrome based on the pre-pregnancy status. METHODS: Korean women who delivered their first child between January 1, 2011, and December 31, 2012, were enrolled. All subjects underwent a national health screening examination conducted by the National Health Insurance Corporation 1 or 2 years prior to their first delivery and within 2 years after their first delivery. RESULTS: Among the 49,065 participants, preeclampsia developed in 3,391 participants (6.9%). The prevalence of metabolic syndrome was higher postpartum in women with preeclampsia than in those without preeclampsia (4.9% vs. 2.7%, respectively, P<0.001). Through the pre-pregnancy to postpartum period, women with preeclampsia had a greater increase in gestational weight retention, body mass index, waist circumference, systolic blood pressure, and triglyceride levels and a greater decrease in high-density lipoprotein cholesterol levels than women without preeclampsia. Preeclampsia was associated with an increased risk of the postpartum development of metabolic syndrome in women without pre-pregnancy metabolic syndrome (odds ratio, 1.28; 95% confidence interval, 1.05–1.56). However, preeclampsia was not associated with postpartum metabolic syndrome in women with pre-pregnancy metabolic syndrome or 2 components of metabolic syndrome. CONCLUSION: In this study, preeclampsia was associated with the postpartum development of metabolic syndrome in women without pre-pregnancy metabolic syndrome. However, the effects were attenuated by predisposing risk factors in the pre-pregnancy period.

Analysis of Pregnancy Outcomes among Interracial Couples in Korea

Although the prevalence of interracial marriages in Korea is increasing, little is known regarding the pregnancy outcomes of interracial couples. The aim of this study was to investigate the differences in pregnancy outcomes between Korean and interracial Korean-foreign couples. Data for infants born in 2011 and 2012 were obtained from the national birth registry of the Korean Statistical Office. The couples were subdivided into Korean father-Korean mother, Korean father-foreign mother, and foreign father-Korean mother groups. Pregnancy outcomes included neonates with low birth weight ( 4,000 g). In 2010 and 2011, 888,447 Korean father-Korean mother, 36,024 Korean father-foreign mother, and 4,955 foreign father-Korean mother neonates were delivered in Korea. After adjustment for parental age, educational level, parity, gestational age at delivery, and neonatal sex, the birth weights were found to be different between groups, with the highest number of foreign father-Korean mother and lowest number of Korean father-foreign mother pregnancies. Based on multivariate logistic regression analysis, the risk of low and large birth weights was higher in the Korean father-foreign mother and foreign father-Korean mother groups, respectively, compared with that in the Korean father-Korean mother group. There are significant differences in pregnancy outcomes including birth weights between Korean and interracial Korean-foreign couples.

Dedifferentiated Endometrioid Adenocarcinoma of the Uterus: Highly Aggressive and Poor Prognostic Tumor

No abstract available.

Clinical and Electrophysiological Changes after Local Steroid Injection in the Carpal Tunnel Syndrome / 대한임상신경생리학회지

BACKGROUND: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period. METHODS: Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment. RESULTS: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months. CONCLUSIONS: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

Torsion of Appendix Misdiagnosed as Ovarian Tumor / 대한내시경복강경외과학회지

Acute appendicitis is the most common cause of an acute abdomen. But torsion of the appendix is a rare disorder that causes abdominal symptoms that are indistinguishable from acute appendicitis. So, making the preoperative diagnosis of torsion of the appendix is difficult. In 1918, Payne et al. reported the first case of torsion of the appendix in a 37 years old woman. Since then, more than thirty cases have been reported. Torsion of the appendix can occur at any age & gender. Here, we report on a case of secondary torsion of appendix with mucinous cystadenoma in a 52 year-old woman, which was initially thought to be a right adnexal mass. Abdomen CT showed an 11x5 cm sized intra-abdominal mass growing along the right fallopian tube. On the small bowel series, an extra-luminal mass was found and this was pushing aside the small intestine. We performed diagnostic laparoscopic exploration and found inflammation of appendix with torsion. It was twisted 720degrees in a clockwise direction with ischemic change. The histological result was mucinous cystadenoma.

Laparoscopic systemic retroperitoneal lymphadenectomy for women with low-risk early endometrial cancer

<p><b>INTRODUCTION</b>There is no consensus on the extent of lymphadenectomy and the appropriate patients for lymphadenectomy in low-risk patients with endometrial cancer. This study aimed to evaluate the feasibility and effectiveness of laparoscopic lymphadenectomy for low-risk patients with endometrial cancer.</p><p><b>MATERIALS AND METHODS</b>From January 2004 to May 2008, we reviewed the medical records of 28 patients with low-risk, endometrial cancer; endometrioid type, grade 1 or 2, and with a depth of myometrial invasion of less than one-half of the myometrium. All patients underwent laparoscopically-assisted staging surgery.</p><p><b>RESULTS</b>The median age and body mass index were 56 years (range, 28 to 75) and 25.5 kg/m(2) (range, 21.3 to 37.2). The median operating time, estimated blood loss, and length of hospital stay were 142 minutes (range, 110 to 410), 215 mL (range, 100 to 700), and 7 days (range, 3 to 19), respectively. No conversion to laparotomy was noted. The median number of harvested lymph nodes was 21 (range, 10 to 48) pelvic nodes and 12 (range, 4 to 21) para-aortic nodes. One (3.6%) patient presented pelvic lymph node metastasis and 2 (7.1%) presented isolated para-aortic lymph node metastasis. The complication rate was 14.3%. No recurrence in the vaginal vault, distant metastasis, port site metastasis was noted up to the last follow-up.</p><p><b>CONCLUSION</b>Systemic pelvic and para-aortic lymphadenectomy should be considered in all low-risk patients with endometrial cancer until it is concluded to be clinically insignificant through large-scale prospective research in the future. However, it will be difficult to explain statistical differences in survival rates according to lymphadenectomy, because the increase of the survival rate resulting from lymphadenectomy will fall within the margin of statistical error.</p>

Laparoscopic management of borderline ovarian tumors; KBSMC experience / 대한산부인과학회지

OBJECTIVE: To evaluate feasibility and efficacy of laparoscopic management for borderline ovarian tumors. METHODS: From May 2005 to October 2007 in our institution, laparoscopic treatments were performed for 16 patients for borderline ovarian tumors. Through clinical records, the patients' age, parity, operating time, tumor diameter, length of hospital stay, change in hemoglobin level, intraoperative and postoperative complications, and recurrence were analyzed. RESULTS: The median age of the patients was 38 years (27-72 years), the median parity was 1 (0-3), and 6 patients were nulliparous., Eight patients were performed conservative surgery, and radical surgery was performed in the remainder. The median operating time was 90 minutes (50-305 minutes), the median hospital stay was 5 days (4-16 days), the median change of the hemoglobin level was 1.5 g/dL (0.2-4.5 g/dL), and the median diameter of the tumors was 8.5 cm. FIGO stage was Ia for 9 patients, Ib for 2, Ic for 4, and IIIc for the last one. Histopathological results showed mucinous tumor for 8 patients, serous tumor for 6, and mixed type and endometrioid tumor for each remaining. Laparoscopic pelvic and paraaortic lymphadenectomy were performed 4 patients. There was no upstaging by intraoperative cystic rupture. Neither laparoconversion nor intraoperative complication was noted. The median duration of follow-up was 20 months (3-53 months) and none showed recurrence. One of 8 patients who were treated conservatively obtained a baby by vaginal delivery in 32th postoperative month. CONCLUSION: This preliminary analysis demonstrated patients with borderline ovarian tumor can feasibly and efficiently undergo laparoscopic management.

Clinical efficacy of laparoscopic myomectomy for 110 cases of various sized myomas / 대한산부인과학회지

OBJECTIVE: To assess the feasibility and clinical efficacy of laparoscopic myomectomy (LM). METHODS: We analyzed retrospectively the data for 110 LM preformed at Kangbuk Samsung Hospital between July 2003 and July 2006. We reviewed their clinical charts and the operative and anesthetic records, and analyzed data on the patients' age, parity, previous operative history, preoperative indication, the diameter of the largest myoma, operating time, number of the removed myoma, hospital stay, change of the hemoglobin concentration from preoperative to postoperative day 1, concomitant procedures, histopathological reports, and complications. RESULTS: The mean age of the patients was 35.7+/-5.8 years, the mean parity was 0.8+/-0.9, and 26 (23%) patients had a previous operative history. The most common operative indication was a palpable abdominal mass (46 patients, 41.9%), followed by chronic pelvic pain (32 patients, 29.0%), abnormal uterine bleeding (24 patients, 21.8%), urinary frequency (7 patients, 6.4%), and infertility (1 patient, 0.9%). The mean operating time was 82.9+/-30.8 minutes, and the mean diameter of the largest myoma was 7.1+/-2.3 cm. The heaviest of the removed myoma weighed 795 gm. The mean change of the hemoglobin concentration was 2.2+/-1.1 g/dL, and the mean hospital stay was 3.5+/-1.4 days. Postoperatively, transfusions were done 10% (11 cases) of patients, and 2 cases of paralytic ileus and a case of subcutaneous emphysema were noted. Conversion rate to laparotomy was 0.9% (1 case). CONCLUSION: LM for various sized myomas can be performed successfully and effectively by decreasing laparoconversion, if the surgical team and the laparoscopic surgeon are experienced and enhanced equipment is available.

Laparoscopic Myomectomy for Large Myomas

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9+/-5.6 yr, mean parity was 0.6+/-0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6+/-38.9 min, and the mean diameter of the largest myoma was 9.3+/-1.8 cm. The mean change in hemoglobin concentration was 2.1+/-1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.

Laparoscopic adnexal surgery for posthysterectomy patients / 대한산부인과학회지

OBJECTIVE: To evaluate the feasibility and effectiveness of laparoscopic adnexal surgery in posthysterectomy patients and review clinical characteristics including comparison of the adhesion score of left with that of right adnexal mass. METHODS: From February 2004 to January 2007, we reviewed the medical records of 23 post-hysterectomy patients who received laparoscopic adnexal surgery including age, parity, type of hysterectomy, operative indications, histopathological diagnosis, operating time, size of the adnexal mass, adhesion score, change in the hemoglobin level, hospital stay, and any complications. RESULTS: The median age of patients was 48 years (range 35-69 years), and median parity was 2 (0-3). The median operating time was 100 minutes (range 35-180 minutes), and the median size of the adnexal mass was 7.1 cm (range 4-12 cm). The median change in hemoglobin level was 1.8 g/dL (range 0.6-4.1 g/dL). The median hospital stay was 4 days (range 3-19 days). The adhesion score was significantly higher in the left adnexal mass than in the right adnexal mass. Histopathological diagnosis included 6 cases of mucinous cystadenoma, 6 cases of functional cyst, 4 cases of hydrosalpinx, 3 cases of serous cystadenoma, 1 case of fibrothecoma, 1 case of mucinous adenofibroma, 1 case of endometrioma, and 1 case of tubo-ovarian abscess. There were no intraoperative complications or conversion to laparotomy. One case of postoperative ileus was noted. CONCLUSION: The skilled laparoscopic surgeon is capable of achieving successful result by performing laparoscopic surgery primarily to patients with adnexal mass for posthysterectomy patients who are expected to suffer severe adhesion. In posthysterectomy patients, left adnexal mass has more extensive adhesion than right adnexal mass, and these finding was represented as a high adhesion score of left adnexal mass.

A case of Listeriosis in early third trimester pregnant woman / 대한산부인과학회지

Although listeria monocytogenes is widely distributed in nature, it rarely causes clinical infection in previously healthy people. However, this microorganism may cause severe infectious disease in pregnant women and newborns due to impaired cell-mediated immunity. Various clinical symptoms have been described such as sepsis, central nervous system infections, endocarditis, gastroenteritis and localized infections. A clinical presentation of listeriosis in an early third trimester pregnant woman and in a preterm infant is emphasized in addition to taking a careful patient history, early empirical administration of antibiotics, aggressive ventilation therapy and also pharmacological support.

A Case of Vasa Previa / 대한산부인과학회잡지

Vasa previa is one of the most unusual and tragic accidents to fetus in obstetrics. This condition is not diagnosed easily because it is rare and unexpected. To improve the perinatal outcome, early detection by ultrasonography is very important during pregnancy. We present a case of vasa previa with velamentous insertion of cord with a brief review of the literatures concerned.

The Significance of the Antral Follicle Number Prior to Stimulation in Predicting the Outcome of Assisted Reproductive Technologies / 대한산부인과학회잡지

BACKGROUND: Recruitment and development of multiple follicles in response to gonadotropin stimulation are the key factors leading to successful treatment by assisted reproductive technologies. Prediction of ovarian responses prior to stimulation is useful in counselling and helpful in adjusting the dosage of gonadotropin to individual patients. OBJECTIVE: To evaluate the number of antral follicles of both ovaries as a predictor of outcome of assisted reproductive technologies. METHODS: Data were collected by a retrospective analysis. A total of 56 consecutive infertile women were undergoing the first cycle using a standard regimen of ovarian stimulation from July, 2000 to June, 2001. Basal FSH, LH, prolactin, and estradiol concentration were measured. The number of follicles (2-5 mm) were recorded. RESULTS: In women with fewer antral follicles, the number of retrieved eggs was significantly decreased and increased the duration and dosage of human menopausal gonadotropin, but pregnancy rate was similar to those with a higher number of antral follicles. CONCLUSION: It is suggested that the total antral follicle number is sensitive ultrasound parameter in predicting the ovarian response.