A Case of Beckwith-Wiedemann Syndrome that Could be Diagnosed by Antenatal Care / 대한주산의학회잡지

Beckwith-Wiedemann syndrome(BWS) is a group of disorders having in common coexistence of a macrosomia, macroglossia, abdominal wall defects, visceromegaly, hypoglycemia in the neonatal period and embryonal cancers of infancy and early childhood. Beckwith-Wiedemann first reported this distinct clinical entity, and about 200cases have subsequently been reported. Etiology is usually sporadic. BWS is a multigenic disorder with dysregulation of the expression of imprinted genes involved in growth and cell cycle control in the 11p15.5 chromosomal region. Placental endocrine dysfunction leading to increased levels of growth hormone and insulin-like growth factors would causes the visceromegaly. Early visceromegaly may pedispose to omphalocele, malrotation anomalies, and diaphragmatic herniation. Detection and treatment of hypoglycemia in any neonate with features of this syndrome are critical. The frequency of hypoglycemia in this population is between 30 and 50%. The majority of infants with hypoglycemia will be asymptomatic and have resolution of the hypoglycemia within the first 3 days of life. Less than 5% of infoots will have hypoglycemia beyound neonatal period one requive either continous feeding or a partial pancreatectomy. We have experienced and case of Beckwith-Wiedemann syndrome so that we report with brief review of the concerned literature.

Effects of an Extract from Cimicifuga racemosa in Menopausal Women / 대한산부인과학회잡지

OBJECTIVE: The aim of the study is to assess the effects of treatment with an extract from Cimicifuga racemosa for 1 year in postmenopausal women with symptoms. METHODS: In a randomised, open-label, group-comparative study, the change on the Kupperman menopausal index, serum FSH and E2 level, bone densitometry (BMD), and mammographic density by an extract from Cimicifuga racemosa (GYNO-Qx ) (N=40) were compared with an conjugated equine estrogen combined with medroxyprogesterone acetate (CEE/MPA) (N=36) during 12 months in menopausal women. RESULTS: There were no statistical differences in the change of Kupperman index, serum FSH and E2 level, and mammographic density between two groups after 12 months, except the effect of BMD that the CEE/MPA group (+6.6%) was significantly increased as compared to the extract from Cimicifuga racemosa (+1.1%) baseline. CONCLUSION: This study suggests that an extract of Cimicifuga racemosa is a safe, effective alternative to estrogen replacement therapy for patients in whom hormone replacement therapy is either refused or contraindicated.

Comparison of Systemic and Transvaginal Local Methotrexate Treatment in Unruptured Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the efficacy of treating of unruptured ectopic pregnancy by systemic and transvaginal local administration of methotrexate. METHODS: We reviewed the medical records of 32 patients who were treated with methotrexate from June 1995 to October 1999. Among the patients, 14 were treated by ultrasound-guided transvaginal local injection and 18 were treated by systemic intramuscular administration. Success rate of the treatment was examined for each group, and the cases of methotrexate failure were characterized and compared with the success group. RESULTS: The success rate was similar between the transvaginal (85.7%) and the systemic (77.8%) groups. There were no differences in initial serum hCG levels, size of gestational sac, fetal cardiac activity between the success group and failure group. CONCLUSION: The results of this study suggest that there is no difference in efficacy between systemic and transvaginal local methotrexate administration, and there are no useful parameters in identifying the risk for the failure of methotrexate treatment.

A Case Report of Trisomy 9 Mosaicism (47,XX,+9/46,XX) / 대한산부인과학회잡지

A rare but typical case of trisomy 9 shows the characteristic phenotype of this syndrome: microcephaly, low-set malformed ears, micrognathia, broad nose with bulbous tip, small and up-slanting palpebral fissures, deep-set eyes, congenital heart diseases, dislocation of joints, abnormal hands and feet, cryptorchidism, micropenis, mental retardation, and growth failure. In addition to karyotyping results, ultrasound findings are important in achieving diagnosis. We experienced a case of trisomy 9 mosaicism (47,XX,+9/46,XX) and so present it with a brief review of literature.

Effect of Human Oviduct Epithelial Cells and Vero Cell on Early Mouse Embryonal Development In Vitro / 대한산부인과학회잡지

OBJECTIVE: The purpose of the study was to determine the effects of co-culture with oviductal epithelial cells and Vero cells on mouse embryo. METHOD: For the control group, mouse embryos were cultured alone in Ham's F-10 with 10% FBS. Subcultured oviductal epithelial cell and Vero cell were cocultured in Ham's F-10 with 10% FBS with the mouse embryo and used as the treatment group. Development of mouse embryos were observed. Result: The development rate and hatching rate of embryos that cocultured with oviductal epithelial cell and Vero cell was significantly higher (p<0.05) than control group. When subcultured oviductal epithelial cells were co-cultured with mouse embryo, there was no significant difference in development rate and hatching rate among subculture step. When oviductal epithelial cells that have been frozen-thawed were co-cultured with mouse embryo, there was no significant difference in development rate and hatching rate among subculture step. No statistical significance was seen in the development rate and hatching rate between subcultured oviductal epithelial cells and frozen-thawed oviductal epithelial cells when cocultured with mouse embryo, Vero cells and frozen-thawed when cocultured with mouse embryo, and Vero cells and oviductal epithelial cells when cocultured with mouse embryo. CONCLUSION: Oviductal epithelial cells and Vero cell may have a stimulatory role in early mouse embryonal development compared to control in vitro. As well, there is no significant difference in development rate and hatching rate among subculture step, when early mouse embryo was cocultured with cells that subcultured and frozen-thawed.

Expression of E-cadherin according to the Presence of High Risk Prognostic Factors, Clinical Stages and Pathologic Types in Cervical Cancer Patients Treated by Radical Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: To analyze the relationship between the degree of expression of E-cadherin and presence of high risk prognostic factors (lymph node metastasis or parametrium involvement), clinical stages and pathologic types in invasive cervical cancer. METHODS: An immunohistochemical technique has been applied to formalin-fixed, paraffin- embedded samples from 20 radical hysterectomy without risk factors and 16 radical hysterectomy with risk factors. The degree of expressions of E-cadherin immunostaining was compared with the International Federation of Gynecology and Obstetrics (FIGO) stage, presence of high risk prognostic factors, and pathologic types. RESULTS: The difference of the degree of expression of E-cadherin was not statistically significant between high-risk group (lymph node metastasis or parametrium invasion) and non-risk group. The difference of the degree of expression of E-cadherin was not statistically significant according to clinical stages and variable pathologic types either. CONCLUSIONS: These results suggest that the degree of the expression of E-cadherin has no relationship with known high risk prognostic factors, clinical stages and pathologic types in invasive cervical cancer.

A comparison of the safety and efficacy of intravaginal prostaglandin E1 ( Misoprostol ) and prostaglandin E2 ( Dinoprostone ) to induce labor / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol(PGE1) versus dinoprostone(PGE2) for labor induction in a prospective controlled trial. METHOD: One hundred eleven patients for labor induction (including preterm rupture of membranes) were randomly assigned to receive either misoprostol 50microgram or dinoprostone 3mg intravaginally. The interval of doses was 8 hours after first dose, with a potential maximum of six dose until active labor pain was achieved. RESULTS: Among 111 patients enrolled, 55 were randomized to receive misoprostol 50microgram and 56 to receive dinoprostone 3mg with every 8 hours interval intravaginally. There were no significant differences in demographic characteristics except in Bishop score(3.81+/-1.52 vs 4.38+/-1.29, P<0.05). There were no significant differences in indications for labor induction. The interval of induction to delivery was shorter in the misoprostol group(750.8+/-518.8min) than in the dinoprostone group(1264.1+/-730.7min). Delivery within 24 hours after administration occurred more often in the misoprostol group than in the dinoprostone group (86.3% vs 65.2%, P<0.05). More than two doses for completion of delivery were frequent in dinoprostone group(36.96% vs 9.8% in misoprostol group, P<0.05). Additional Oxytocin augmentation was needed more commonly in the misoprostol group(3.64%) than in the dinoprostone group(14.29%)(P<0.05), but no significant differences were noted between two groups in total oxytocin doses and indications. Tachysystole occurred more often in the misoprostol group (12.73% vs 1.79% in the dinoprostone, P<0.05) Precipitating delivery occurred more commonly in the misoprostol group(21.82% vs 7.14% in the dinoprostone group, P<0.05). No differences in the cesarean section rate, fetal heart rate abnormalities, hyperstimulation syndrome, meconium staining, fetal outcome (Apgar score at 1 and 5 minutes, birth weight), and marternal outcome (nausea and vomitting, postpartum bleeding) were noted. The cost of misoprosl is one hundredth cheaper than dinoprostone. There was no significant differences in the fetal outcome and maternal outcome. CONCLUSION: These results suggest that intravaginal misoprostol(PGE1) is a safe drug for labor induction which is more effective and cheaper compare to intravaginal dinoprostone(PGE2).

A Case of Cervical Pregnancy Treated by both Intraamniotic and Systemic Methotrexate Injection / 대한산부인과학회잡지

Cervical pregnancy is a rare form of ectopic pregnancy and it can cause life-threatening bleeding. Until recently abdominal hysterectomy has been considered the standard therapy for fear of profuse hemorrhage. Methotrexate, however, can be useful agent to conserve further fertility and it is used in various routes of administration. We report a case of cervical pregnancy that was successfully treated by intraamniotic methotrexate injection under the guidance of transvaginal ultrasonography and subsequent four systemic doses thereafter.

Effect of Coculture System with Autologous Cumulus Cells on Embryo Quality and Pregnancy Rates / 대한불임학회지

Despite the rapid development of assisted reproductive technologies (ART) in recent years, implantation rates after replacement of embryos into the uterine cavity remains low. Several techniques such as culture conditions based on formulations of human tubal fluid and various ART techniques as GIFT, ZIFT, TET have been adopted in recent years to improve embryo viability in vitro and implantation rates. Also, coculture of human IVF-derived embryos have been used in an effort to increase the number of viable embryos following IVF and to improve synchrony between the developing embryo and the uterine environment. The aim of this study was to evaluate whether the use of coculture with autologous cumulus cells has a significant beneficial effect on the development of embryos in vitro and its relation to the pregnancy rates in 120 patients with previous failed IVF-ET from September, 1995 to January 1998. We obtained the results from which significant improvement in the quality of viable embryos were observed using a coculture system with autologous cumulus cells, but pregnancy rates in this group of patients did not differ from the rate in the standard IVF group during the same period. Our study shows that a simplified short-term coculture system with autologous cumulus cells may help rescue moderate quality embryos to cleave regularly.

A Clinical Study of Hyperprolactinemia in Women with Different Menstrual Patterns / 대한산부인과학회잡지

Disorders derived from abnormal prolactin(PRL) production are relatively common ingynecological practice. Infertility, menstrual disorders, and galactorrhea are the most frequentmanifestations encountered in women. And, although frequently benign, the disordersoccasionally may have severe consequences.We studied 341 infertile women with normal menstruation(N group) and 105 womenwith oligomenorrhea(O group) and 70 women with secondary amenorrhea(A group), first; to investigate the prevalence of hyperprolactinemia(hPRL) and its clinical etiologies in 3groups, second; to estimate the effect of the bromocriptine(BRMC) treatment in N group,and finally; to obtain an understanding of the underlying physiology and pathoghysiologycoupled with the awareness of the hetrogeneous presentation of hPRL from June, 1994 toDecember, 1996.The results of this study were as follows;1. There were no significant correlations of serum PRL levels by ages in 3 groups.2. The prevalence rates of conventional hPRL(PRL>25ng/mL) were 18.2% in N group,22.9% in O group, 28.6% in A group and were not different among 3 groups(P=0.12).But the rates of PRL>50 ng/mL were 4.7%, 7.6%, 20.0%, respectively and were different(p < 0.01).3. The most common causes of hPRL were prolactinomas(9.3%) and thyroid disorders(4.7%) except the undiagnosed(72.1%).4. The cumulative pregnancy rates of 6~24 months duration were not different betweenBRMC-treated women(33.3%) and BRMC-untreated women(38.9%) in N group(p=0.92).

A Hospital Based Case-Control Study for the Effects of Maternal Anemia on the Preterm Birth andAdverse Pregnancy Outcomes / 대한산부인과학회잡지

OBJECTIVE: Maternal anemia is one of the most common hematologic disorders of the child-bearingmothers. However the role of maternal anemia in the etiology of preterm delivery and adverse pregnancyoutcomes remains a source of controversy. The aim of this study was to determine the effects of maternalanemia on the preterm birth and the adverse pregnancy outcomes. STUDY DESIGN: A total of 1,010 women aged 19~44 years, who admitted to our hospitalfor the delivery between December 1994 and October 1995, were recruited into a hospitalbaed case-control study design. 259 women complicated by maternal anemia(cases) werecompared with 751 women without maternal anemia(controls). Multiple logistic regressionanalyses were performed to control for the effects of other potentially confounding factors,including maternal age, body mass index, previous term delivery, previous preterm deliveryand previous abortion. In all logistic regression analyses odds ratio and 95% confidenceintervals were calculated. RESULTS: The prevalence of maternal anemia(hemoglobin<10g/dl) was 25.6%. Therewas a positive linear relationship between the prepartum hemoglobin concentration and thepostpartum concentration. There was no significant differences of the incidence of pretermbirth and the neonatal morbidity, such as poor Apgar scores, fetal distress, congenitalanomaly, birth trauma, admission to neonatal intensive care unit, resuscitation and sepsisbetween case and control groups. Small for gestational age and low birth weight were associatedwith an somewhat decreased risk of maternal anemia and large for gestational age, notmacrosomia, was associated with an 70% increased risk of maternal anemia at the time ofdelivery. Maternal anemia was associated with 6.5 fold increases in the risks of postpartumbleeding, 8.5 fold increases in the postpartum transfusion and 80% increases in the puerperalfever respectively. CONCLUSIONS: Maternal anemia was not associated with increased risks of preterm birthand the neonatal morbidty. However there was a significant relationship between maternalanemia and postpartum maternal morbidity, such as postpartum bleeding, postpartum transfusionand puerperal fever.

A study of endogenous gonadotropin suppression with oral contraceptives and triggering follicular maturation with GnRH-a before in vitro fertilization / 대한산부인과학회잡지

No abstract available.

The treatment of unruptured tubal pregnancy with intra-amniotic methotrexate injection under transcaginal sono-guidance / 대한산부인과학회잡지

No abstract available.

A study of low dose purified follicle-stimulating hormone supplemented with gonadotropin releasing hormone agonist in women with polycystic ovarian disease / 대한산부인과학회잡지

No abstract available.