The power of the Risk of Ovarian Malignancy Algorithm considering menopausal status: a comparison with CA 125 and HE4 / 부인종양

OBJECTIVE: To identify the power of tumor markers for predicting ovarian cancer according to menopausal status. METHODS: The medical records of 876 women with ovarian cysts were retrospectively reviewed. Cancer antigen 125 (CA 125), human epididymis protein 4 (HE4), and Risk of Ovarian Malignancy Algorithm (ROMA) were analyzed. Sensitivity, specificity, and the receiver operating characteristic (ROC) curve analyses of these tumor markers were evaluated. RESULTS: The sensitivity of ROMA was 66.7% and the specificity was 86.8% to detect ovarian malignancy. The patients were divided into 2 groups according to menopausal status: premenopause (n=532, 60.7%) and postmenopause (n=344, 39.3%). For diagnostic accuracy, ROMA was lower than HE4 in premenopausal women (82.7% vs. 91.4%) and lower than CA 125 in postmenopausal women (86.9% vs. 88.7%). The ROC curve analysis revealed that the power of ROMA was not significantly better than that of HE4 in premenopausal women (area under the curve [AUC], 0.731 vs. 0.732, p=0.832), and it was also not significantly better than that of CA 125 in postmenopausal women (AUC, 0.871 vs. 0.888, p=0.440). CONCLUSION: The discrimination power of tumor markers for ovarian cancer was different according to menopausal status. In predicting ovarian malignancy, ROMA was neither superior to HE4 in premenopausal women nor superior to CA 125 in postmenopausal women.

Comparison of the clinical outcome of frozen-thawed embryo transfer with and without pretreatment with a gonadotropin-releasing hormone agonist

OBJECTIVE: To describe the clinical outcomes of frozen-thawed embryo transfer (FET) with artificial preparation of the endometrium, using a combination of estrogen (E2) and progesterone (P4) with or without a gonadotropin-releasing hormone agonist (GnRHa), and the modified natural cycle (MNC) with human chorionic gonadotropin (hCG) trigger. METHODS: In this retrospective study, we evaluated 187 patients during 3 years (February 2012–April 2015). The patients were allocated to the following treatment groups: group A, comprising 113 patients (181 cycles) who received GnRHa+E2+P4; group B, comprising 49 patients (88 cycles) who received E2+P4; and group C, comprising 25 patients (42 cycles) who received hCG+P4. The inclusion criteria were regular menstrual cycles (length 24–35 days) and age 21–45 years. RESULTS: The primary outcome of the study — implantation rate (IR) per embryo transferred — was not statistically different among the 3 groups. Similar results were found for the IRs with fetal heartbeat per embryo transferred (68/181 [37.6%] in group A vs. 22/88 [25.0%] in group B vs. 14/42 [33.3%] in group C) and for the live birth rates (LBRs) per embryo transferred (56/181 [30.9%] in group A vs. 18/88 [20.5%] in group B vs. 11/42 [26.2%] in group C). CONCLUSION: Although the pregnancy outcomes were better in the hormone therapy with GnRHa group, hormone therapy FET with GnRHa for pituitary suppression did not result in significantly improved IRs and LBRs when compared with hormone therapy FET without GnRHa or MNC FET.

Analysis of the Vaginal Microbiome by Next-Generation Sequencing and Evaluation of its Performance as a Clinical Diagnostic Tool in Vaginitis

BACKGROUND: Next-generation sequencing (NGS) can detect many more microorganisms of a microbiome than traditional methods. This study aimed to analyze the vaginal microbiomes of Korean women by using NGS that included bacteria and other microorganisms. The NGS results were compared with the results of other assays, and NGS was evaluated for its feasibility for predicting vaginitis. METHODS: In total, 89 vaginal swab specimens were collected. Microscopic examinations of Gram staining and microbiological cultures were conducted on 67 specimens. NGS was performed with GS junior system on all of the vaginal specimens for the 16S rRNA, internal transcribed spacer (ITS), and Tvk genes to detect bacteria, fungi, and Trichomonas vaginalis. In addition, DNA probe assays of the Candida spp., Gardnerella vaginalis, and Trichomonas vaginalis were performed. Various predictors of diversity that were obtained from the NGS data were analyzed to predict vaginitis. RESULTS: ITS sequences were obtained in most of the specimens (56.2%). The compositions of the intermediate and vaginitis Nugent score groups were similar to each other but differed from the composition of the normal score group. The fraction of the Lactobacillus spp. showed the highest area under the curve value (0.8559) in ROC curve analysis. The NGS and DNA probe assay results showed good agreement (range, 86.2-89.7%). CONCLUSIONS: Fungi as well as bacteria should be considered for the investigation of vaginal microbiome. The intermediate and vaginitis Nugent score groups were indistinguishable in NGS. NGS is a promising diagnostic tool of the vaginal microbiome and vaginitis, although some problems need to be resolved.

Systemic Classification for a New Diagnostic Approach to Acute Abdominal Pain in Children / 대한소아소화기영양학회지

PURPOSE: With previous methods based on only age and location, there are many difficulties in identifying the etiology of acute abdominal pain in children. We sought to develop a new systematic classification of acute abdominal pain and to give some helps to physicians encountering difficulties in diagnoses. METHODS: From March 2005 to May 2010, clinical data were collected retrospectively from 442 children hospitalized due to acute abdominal pain with no apparent underlying disease. According to the final diagnoses, diseases that caused acute abdominal pain were classified into nine groups. RESULTS: The nine groups were group I "catastrophic surgical abdomen" (7 patients, 1.6%), group II "acute appendicitis and mesenteric lymphadenitis" (56 patients, 12.7%), group III "intestinal obstruction" (57 patients, 12.9%), group IV "viral and bacterial acute gastroenteritis" (90 patients, 20.4%), group V "peptic ulcer and gastroduodenitis" (66 patients, 14.9%), group VI "hepatobiliary and pancreatic disease" (14 patients, 3.2%), group VII "febrile viral illness and extraintestinal infection" (69 patients, 15.6%), group VIII "functional gastrointestinal disorder (acute manifestation)" (20 patients, 4.5%), and group IX "unclassified acute abdominal pain" (63 patients, 14.3%). Four patients were enrolled in two disease groups each. CONCLUSION: Patients were distributed unevenly across the nine groups of acute abdominal pain. In particular, the "unclassified abdominal pain" only group was not uncommon. Considering a systemic classification for acute abdominal pain may be helpful in the diagnostic approach in children.

Contributing Factors Analysis for the Changes of the Gross Motor Function in Children With Spastic Cerebral Palsy After Physical Therapy

OBJECTIVE: To investigate the factors which contribute to the improvements of the gross motor function in children with spastic cerebral palsy after physical therapy. METHODS: The subjects were 45 children with spastic cerebral palsy with no previous botulinum toxin injection or operation history within 6 months. They consisted of 24 males (53.3%) and 21 females (46.7%), and the age of the subjects ranged from 2 to 6 years, with the mean age being 41+/-18 months. The gross motor function was evaluated by Gross Motor Function Measure (GMFM)-88 at the time of admission and discharge, and then, the subtractions were correlated with associated factors. RESULTS: The GMFM-88 was increased by 7.17+/-3.10 through 52+/-16 days of physical therapy. The more days of admission, the more improvements of GMFM-88 were attained. The children with initial GMFM-88 values in the middle range showed more improvements in GMFM-88 (p<0.05). The children without dysphagia and children with less spasticity of lower extremities also showed more improvements in GMFM-88 (p<0.05). CONCLUSION: We can predict the improvements of the gross motor function after physical therapy according to the days of admission, initial GMFM-88, dysphagia, and spasticity of lower extremities. Further controlled studies including larger group are necessary.

A variant of complete septate uterus with double cervix and vagina: A case report / 대한산부인과학회지

Rare mullerian anomalies without any present classification were sometimes reported. A 30-year-old nulligravid woman was referred to our hospital with 2-year history of primary infertility. Laparoscopic examination revealed a relatively intact uterine fundus with both patent fallopian tubes. Hysteroscopic exam confirmed the presence of double vagina and cervix, as well as complete uterine septum with opening at the lower segment. Hysteroscopic septotomy was successfully performed through the right-sided cervix. A variant of complete septate uterus with double cervix that communicated at the isthmic portion could be successfully treated by hysteroscopic operation.

Transient newborn neutropenia immediately after chemotherapy during pregnancy: A case report / 대한산부인과학회지

The incidence of acute leukemia in pregnancy is as low as 1 in 75,000 pregnancies. There is no established guideline for the treatment of leukemia during midtrimester pregnancy. But nowadays, consensus is not to delay the leukemia treatment with chemotherapy even in pregnancy. Many authors reported successful outcomes of mothers and newborns. Because of the leukemia itself and side effects of the chemotherapy, anemia, thrombocytopenia and neutropenia are commonly encountered in women treated with chemotherapy. With chemotherapy in utero just before the delivery, the newborn could be neutopenic. We report one case of midtrimester pregnant woman who took chemotherapy for leukemia and suffered from neutropenic fever and preterm labor. The newborn was neutropenic. However, both the mother and the baby were successfully recovered from neutropenia.

Current Status and Activation Plan of Hospice Palliative Care in Korea - Based on Hospice Palliative Care Facilities Survey / 한국호스피스완화의료학회지

PURPOSE: This study aimed to evaluate the current status of hospice palliative care facilities in Korea. Based on the result, we attempted to suggest activation plans of hospice palliative in Korea. METHODS: To conduct a survey, we obtained a list of hospice palliative care facilities from related agencies and academic societies. A survey was conducted from February, 2009 to March, 2009. The survey was consisted of general characteristics of organizations, manpower, facilities & equipments, and so on. In addition, we used data from Statistics Korea to estimate the number of beds required and the bed occupancy rate. RESULTS: Total number of facilities responded to the questionnaire were 53. Forty-two facilities were general hospitals and 6 facilities were clinics among the total 53 facilities, and 18.8% of facilities were located in Seoul, Incheon and Gyeonggido. Overall bed occupancy rate was rather low as 21.9%, and there were 4 provinces where bed occupancy rates were 0%. Deaths in hospice palliative care facilities during 2008 were 6.3% of total deaths from cancers. As for the questions about the financial status of facilities, 86% of facilities were answered financial insufficiency. Also more than half of the facilities gave financial insufficiency as the reason for shortage of human resource supplies and inability to achieve the standard for authorization by the government. Facilities answered in order to activate the hospice palliative care, governmental support is needed, mostly in financial support (71.2%), donation tax deduction (43.1%), and setting up a public utility foundation (23.5%). CONCLUSION: This study showed low rates of hospice palliative care use and bed occupancy in Korea. Regional variance in bed occupancy rate was significantly high. As a roadblock for these problems, most of the facilities cited financial insufficiency. Therefore, there must be some action plans to boost financial support to activate hospice palliative care in Korea. Finally, efforts to improve these circumstances including lack of understanding about hospice and palliative care, are needed as well.

A case of Bartter syndrome type I with atypical presentations / 소아과

Bartter syndrome (BS) is an autosomal recessively inherited rare renal tubular disorder characterized by hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism with normal to low blood pressure due to a renal loss of sodium. Genetically, BS is classified into 5 subtypes according to the underlying genetic defects, and BS is clinically categorized into antenatal BS and classical BS according to onset age. BS type I is caused by loss-of-function mutations in the SLC12A1 gene and usually manifests as antenatal BS. This report concerns a male patient with compound heterozygous missense mutations on SLC12A1 (p.C436Y and p.L560P) and atypical clinical and laboratory features. The patient had low urinary sodium and chloride levels without definite metabolic alkalosis until the age of 32 months, which led to confusion between BS and nephrogenic diabetes insipidus (NDI). In addition, the clinical onset of the patient was far beyond the neonatal period. Genetic study eventually led to the diagnosis of BS type I. The low urinary sodium and chloride concentrations may be caused by secondary NDI, and the later onset may suggest the existence of a genotype-phenotype correlation.

A third stage pelvic organ prolapse due to cervical swelling during labor: A case report / 대한산부인과학회지

Pelvic organ prolapse complicating pregnancy is a rare clinical condition and its incidence is one in 10,000~15,000 deliveries. It is associated with multiparity, low socioeconomic status, inadequate perinatal care, maternal malnutrition, previous abdominal surgery, and weakness of pelvic muscular and connective tissue. It can cause cervical dystocia, which leads to cervical laceration, uterine rupture, maternal and fetal death. We experienced a case, first in Korea, of cervical swelling that developed during labor, prolapsed beyond the vaginal introitus and thus obstructed the birth canal. The patient underwent cesarean section and subsequently received MgSO4 topical therapy and resulted in complete resolution. We report this case with a brief review of literature.