Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study

OBJECTIVE: To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. METHODS: One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. RESULTS: The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale > or =10 and Beck Depression Inventory > or =10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). CONCLUSION: PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression.

Successful management of maternal factor VII deficiency in a cesarean section

Factor VII (FVII) deficiency is an infrequent hereditary bleeding disorder that can make excessive bleeding in surgical interventions, such as a postpartum hemorrhage in a cesarean section. Although a recombinant form of activated FVII has been applied for bleeding control in FVII-deficient patients, its applications in the field of obstetrics are still limited, especially in Korea. Replacement of blood products is still preferred as first-line therapy, with antifibrinolytic agents used as adjunctive therapy. We report herein the case of a successful cesarean section in an 18-year-old woman with FVII deficiency.

Endometrioid Adenocarcinoma Arising from Endometriosis of the Uterine Cervix: A Case Report

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix is rare in premenopausal woman. We describe here a patient with this condition and review the clinical and pathological features of these tumors. A 48-yr-old woman complaining of severe dysmenorrhea was referred for investigation of a pelvic mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological examination revealed an endometrioid adenocarcinoma directly adjacent to the endometriosis at the uterine cervix, with a transition observed between endometriosis and endometrioid adenocarcinoma. The patient was diagnosed as having endometrioid adenocarcinoma arising from endometriosis of the uterine cervix and underwent postoperative chemotherapy. Gynecologists and pathologists should be aware of the difficulties associated with a delay in diagnosis of endometrioid adenocarcinoma arising from endometriosis when the tumor presents as a benign looking endometrioma.

A case of small cell carcinoma of pulmonary type of ovary associated with huge mucinous cystadenocarcinoma / 대한산부인과학회지

Small cell carcinoma of ovary is extremely rare. This neoplasms compose predominantly or exclusively of small round cells with scant cytoplasm. There are two types of primary small cell carcinoma of ovary described in the literature : the hypercalcemic type and the pulmonary type. The first 11 patients with a primary ovarian small cell carcinoma of the pulmonary type were described by Eichorn et al. in 1992. The prognosis of this tumor is very poor and only limited data on the treatment of this tumor type are available. In the present case report, we describe a patient with the pulmonary type of small cell carcinoma associated with huge mucinous cystadenocarcinoma with a brief review of the concerned literatures.

An analysis of the risk factors for metabolic syndrome affecting stress urinary incontinence in korean middle-aged and older women / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to identify the relationship between metabolic syndrome and stress urinary incontinence. METHODS: Based form 362 case, the risk factors including the parameters of metabolic syndrome for stress urinary incontinence (SUI) were analyzed retrospectively: body mass index (BMI), hypertension, insulin resistance, triglyceride, HDL-cholesterol. RESULTS: The risk for metabolic syndrome were associated positively with SUI. Women with the risks for metabolic syndrome had 2.503 times of the odds for SUI compared without the risks for metabolic syndrome (95% CI 1.28-4.87, p<0.001). The independent risk factors for SUI were BMI (OR 3.574 ; 95% CI 0.09-0.31, p<0.001) and insulin resistance (OR 2.563 ; 95% CI 0.04-0.31, p=0.011) by multivariate analysis. CONCLUSION: Our results suggested that metabolic syndrome was the important factor of the stress urnary incontinence. And we confirmed the need for the treatment of metabolic disturbance and the prevention of metabolic syndrome aimed at correcting hormonal-metabolic disturbance in middle-aged and older women with SUI.

Female adnexal tumor of probable Wolffian origin: A Case Report / 대한산부인과학회지

Female adnexal tumors of probable Wolffian origin (FATPWO) were first reported in 1973 and the disease is a rare clinical entity. They are often found in the leaves of the broad ligament, ovary and paravaginal tissue. We report a 40-year-old woman who presented with both adnexal masses filling the pelvic cavity which were hard and fixed on palpation, and the masses were radiologically diagnosed as both ovarian fibroma-thecomas on the CT scan. The left adnexal mass was surgically excised and pathologically proved to be fibroma, the left adnexal mass was excised and pathologically proved to be FATPWO.

An Analysis of the Metabolic Syndrome and the Clinicopathologic Prognostic Factors Affecting Survival in Patients with Uterine Endometrial Cancer / 대한산부인과학회지

OBJECTIVE: We aimed to evaluate the metabolic syndrome and the clinicopathologic prognostic factors of endometrial cancer results from 35 surgically staged patients and to find out those novel prognostic factors. METHODS: This study is based on 35 endometrial cancer patients. Difference of survival rate in the following histologic parameters and parameter of metabolic syndrome was analyzed: age, body mass index (BMI), hypertension, insulin resistance, triglyceride, HDL-cholesterol, FIGO stage, tumor grade, myometrial invasion, cervical involvement, adnexal metastasis, and lympho-vascular space invasion (LVSI). Concerning lymph node involvement, the ratio of metastatic lymph node to dissected lymph node (metastatic ratio: MR) was calculated in total pelvic lymph node. MR was divided into less than 0.5 to more than 0.5. In each group, 5-year survival rate (5YSR) was analyzed and compared. RESULTS: The overall 5YSR for all 35 patients was 78.8%. The 5YSR for insulin resistance and normal insulin tolerance were 94.1%, 33.6% (p=0.009). LVSI, adnexal metastasis and MR of pelvic lymph node were independent prognostic factors for the endometrial cancer patients. CONCLUSION: Our results suggested that there was a relationship between insulin resistance and endometrial cancer and we confirmed the need for the treatment of metabolic disturbance and the prevention of metabolic syndrome aimed at correcting hormonal-metabolic disturbance in endometrial cancer patients. The MR of pelvic lymph node is thought that one of the most important prognostic factor of the endometrial cancer.

Ex vivo expansion of umbilical cord blood-derived T-lymphocyte with autologous cord blood plasma / 대한산부인과학회지

OBJECTIVE: The objective of this study was to establish a clinically applicable culture system by investigating the use of autologous cord blood plasma (ACBP) instead of fetal bovine serum (FBS) for the ex vivo expansion of umbilical cord blood (UCB) T-lymphocytes. METHODS: Fresh UCB mononuclear cell (MNC) fractions were isolated by Ficoll-Hypaque density centrifugation. The nonadherent MNC fractions were then cultured with the anti-CD3 antibody 5 microgram/mL plus IL-2 175 U/mL in the presence of 10% FBS, 10% ACBP or homologous cord blood plasma (HCBP). On day 8, proliferation rate, cell surface markers, cytotoxic assay of UCB T-lymphocytes according to the medium supplemented with FBS, ACBP or HCBP were evaluated. RESULTS: Proliferation studies demonstrated a significant increase in the proliferative ability of UCB T-lymphocytes incubated in anti- CD3 and IL-2 irrespective of the medium supplemented with FBS or ACBP. In the FBS supplemented medium, expressions of the activated T-lymphocytes were increased significantly after culture: CD3+CD8+, CD3+CD25+, CD3+CD38+, and CD45RO+ (p<0.05). Also in the ACBP supplemented medium, expressions of the activated T-lymphocytes were increased significantly after culture: CD3+ CD8+, CD3+CD25+, and CD45RO+ (p<0.05). In the HCBP supplemented medium, expressions of the activated T-lymphocytes were increased significantly after culture as in the ACBP: CD3+CD8+, CD3+CD25+, and CD45RO+ (p<0.05). Of the activated T-lymphocytes, increase of cytotoxic CD3+CD8+ cells increased significantly in the ACBP and HCBP groups compared to FBS group (p<0.05). CONCLUSION: These findings support the feasibility of ex vivo expansion of umbilical cord blood T-lymphocytes in the medium supplemented with autologous cord blood plasma, instead of fetal bovine serum, for future adoptive cellular immunotherapy.

Retained Surgical Sponge that Eroded into Small Intestinal Lumen / 대한산부인과학회잡지

Foreign bodies retained in the peritoneal cavity rarely are documented, owing to medical, legal, and other reasons. A retained surgical sponge in the peritoneal cavity may cause symptoms both in the early postoperative period as well as months or years after the original operation. Among the complications reported following retention of surgical pads and sponges are obstruction, peritonitis, adhesions, abscess formation, erosion into the gastrointestinal lumen, and extrusion via the rectum. Erosion of a surgical sponge into the bowel is uncommon. We report a 33-year-old woman in whom retained surgical sponge eroded into the small bowel and produced unusual radiologic findings and complications.

A Case of Intracerebral Hemorrhage During Labor Without History of Preeclampsia / 대한산부인과학회잡지

Cerebrovascular disorders (infarction and intracranial hemorrhage), otherwise collectively referred to as stroke, are an uncommon and feared complication of pregnancy. Collectively, these disorders contribute up to 12% of all maternal deaths. Because of the common presentation with seizures, hypertension, proteinuria, and visual disturbance there has been diagnostic confusion with eclampsia, especially when cerebrovascular disorders occur antepartum or intrapartum. This case is intended to assist the clinician with clues for prompt diagnosis and therapy for this uncommon and unpreventable medical complication of pregnancy.

Alpha-Fetoprotein Producing Sertoli-Leydig Cell Tumor of the Ovary: A Case Report

A 26-year-old woman had an ovarian Sertoli-Leydig cell tumor (SLCT) associated with an elevated level of serum alpha-fetoprotein (AFP). The tumor had a heterologous element of intestinal-type mucinous epithelium, retiform and intermediately differentiated tubules of the Sertoli cells, and AFP-producing Leydig cells. AFP was demonstrated within the Leydig cells by an immunohistochemical technique. After surgery, the serum AFP level of the patient fell to the normal range. The present case is the first documented case of AFP producing a SLCT of the ovary reported in Korea.

Cyclooxygenase-2 Expression and Angiogenesis in Invasive Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumor growth and angiogenesis of gastrointestinal and other cancers. This was the study to determine the relationship between tumor vascularity and COX-2 expression in invasive cervical cancer. METHODS: We examined the expression of COX-2 and microvessel density (MVD) by immunohis- tochemical staining in 21 specimens collected from invasive cervical cancer patients. RESULTS: All specimens showed weak and strong immunoreactivity, with 52.4% strong reactivity. Microvessel count was higher (median 136) in the strong COX-2 immunoreactivity specimens than the weaks (median 90), and MVD was significantly correlated with the COX-2 immunoreactivity (P=0.002). CONCLUSION: These preliminary data indicate that overexpression of COX-2 may play an important role in carcinogenesis of cervical cancer and this could be partially attributable to modulation of angiogenesis by COX-2. COX-2 maybe a target for future research in the tumorigenesis of the invasive cervical cancer.

A case of Pelvic Actinomycosis Associated with Intrauterine Device / 대한산부인과학회잡지

Actinomycosis is a chronic, progressive, suppurative disease which appears to be difficult to establish a correct preoperative diagnosis. Most of pelvic actinomycosis in women are related to a long time intrauterine device(IUD) inserted state. The causative agent is a branching, gram-positive anaerobic or microaerobic organism, not fungi. Ascending infection of the upper genital tract by actinomycosis may be clinically inapparent. We experienced a case of clinically inapparent tuboovarian actinomycosis in a 47-year-old women with IUD, discovered pathologically after laparotomy.

The efficacy of nuchal translucency with free beta-hCG, PAPP-A as a screening test for detection of chromosomal anomaly in the first trimester of pregnancy / 대한산부인과학회잡지

OBJECTIVES: The aim of this study is to determine the efficacy of nuchal translucency in combination with free beta-hCG, PAPP-A in the first trimester screening for chromosomal anomaly in general population. METHODS: Between April 1998 and December 1999, we evaluated 263 pregnant women undergoing first trimester screening test for fetal chromosomal anomaly using nuchal translucency combined with free beta-hCG, PAPP-A. We confirmed the pregnancy outcomes through chorionic villi sampling, amniocentesis or term delivery. We excluded 15 pregnant women because of their obscure pregnancy outcomes. Statistical analysis was considered significant when P value was lower than 0.05. RESULTS: With a risk cut-off of 1 in 400, 24 pregnancies(9.7%) of 248 cases were screen positive and 224 pregnancies(90.3%) were screen negative. 2 cases of Down syndrome and 1 case of Turner syndrome were detected in screen positive group. No chromosomal anomalies were detected in screen negative group. CONCLUSION: In this study, 8.57% of false positive rate and 12.5% of positive predictive value were obtained in the first trimester screening for chromosomal anomaly using nuchal translucency and serum markers.

Cyclooxygenase-2 Expression in Ovarian Tumors / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2 (COX-2) is important in tumorigenesis of gastrointestinal and other cancers. This was the study to determine whether COX-2 was also expressed in benign and malignant ovarian tumors. METHODS: We studied the expression of COX-2 in various ovarian tumors [ Benign epithelial tumors (n=10), borderline epithelial tumors (n=12), malignant epithelial tumor (n=12), nonepithelial tumors(n=10) ] by immunohistochemistry. Results of immunoreactivity was classified semiquantitatively based on the proportion and intensity of tumor cell immunostaining. RESULTS: In the epithelial ovarian tumors, the intensity of immunostaining was stronger in the malignant tumors than the benign and borderline tumors (p<0.001). Especially all serous and mucinous malignant tumors (n=9) showed weak and strong immunoreactivity, with 66.7% strong reactivity. None of the nonepithelial ovarian tumors expressed COX-2 immunoreactivity. CONCLUSION: These preliminary data indicate that COX-2 may have a role in carcinogenesis of epithelial ovarian tumors, especially in the serous and mucinous types. COX-2 maybe a target for future research in the tumorigenesis of the epithelial ovarian malignancies.

Aggressive Angiomyxoma of the Vagina / 대한산부인과학회잡지

Aggressive angiomyxoma is a rare pathological condition which affects mainly the soft tissues of the pelvis and perineum in women. It is circumscribed totally or partially and has a infiltrative margin, so it has a tendency for local recurrence. We report a 33-year-old woman who presented with a mass arising within the vaginal wall which was painless, soft and movable like a cyst on palpation. The mass was surgically excised and pathologically proved to be an aggressive angiomyxoma.

Cyclooxygenase - 2 Expression in Cervical Intraepithelial Neoplasia and Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: A large body of evidence suggests that cyclooxygenase-2(COX-2) is important in tumorigenesis of gastrointestinal cancer. The purpose of this study was to determine whether COX-2 was also expressed in cervical intraepithelial neoplasia(CIN) and invasive cervical carcinoma. METHODS: We studied the expression of COX-2 in normal cervix(n=6), CIN I(n=4), CIN II(n=2), CIN III(n=15), microinvasive carcinoma(n=5) and invasive carcinoma(n=7) by immunohistochemistry. RESULTS: We observed strong COX-2 expression in 16.7% of the normal cervix, 0% of the CIN I and II, 80.0% of CIN III, 60.0% of microinvasive carcinoma and 71.4% of invasive carcinoma. The intensity of immunostaining was stronger in the CIN III and invasive cancer than the normal cervix and CIN I lesions(p<0.01). CONCLUSION: These results suggest that COX-2 may have a role in carcinogenesis of CIN and may be a target for the prevention or treatment of CIN and invasive cervical cancer.

A study of Cytokine in Peritoneal Fluid of Infertile Patients with Endometriosis / 대한불임학회지

OBJECTIVE: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine lefels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-alpha) in infertile women with endometriosis and normal women without endometriosis. Design : Prospective and case-control study in university hospital. MATERIALS AND METHODS: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzymelinked immunosorbent assay. RESULTS: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were 72.7+/-23.7 pg/ml and 18.5+/-9.7 pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls (445.0+/-89.6, vs 45.1+/-48.4, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls (1.09+/-0.04 vs 2.19+/-0.03, p=0.03). The level of tumor necrosis factor-alpha was not significantly different between the two study groups. CONCLUSIONS: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.