Study for umbilical cord plasma leptin in gestational diabetes and normal pregnancy / 대한산부인과학회지

OBJECTIVE: To compare umbilical cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects and to evaluate the regulation of leptin in GDM. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human Leptin RIA kit; Linco Research, Inc. USA). We compared cord plasma leptin level between gestational diabetes (n=18 women) and control pregnancies (n=21 women). RESULTS: Maternal weight, fetal birth weight, Ponderal index and placental weight were significant variables among the demographic variables. There was statistical difference in cord plasma leptin level between infants of mothers with gestational diabetes and infants of control subjects (Control subjects: 4.8 [3.7-7.9]ng/mL, GDM women: 8.0 [6.6-11.9]ng/mL, P=0.022). There was also statistical difference in the ratio between cord plasma leptin level and birth weight (Control subjects: 0.001 [0.001-0.002]ng/mL/gm, GDM women: 0.002 [0.002-0.003]ng/mL/gm (P=0.022)), and between cord plasma leptin level and Ponderal index (Control subjects: 0.280 [0.217-0.579], GDM women: 0.605 [0.452-1.005], (P=0.008)). There was no difference in gender. CONCLUSION: We found significant difference in umbilical cord plasma leptin level and adjusted leptin level for fetal birth weight, Ponderal index and placental weight between infants of mothers with gestational diabetes and infants of control subjects. It is suggested that umbilical cord plasma leptin is produced by fetal fat tissue, but it is more complicatedly regulated by placenta and other factors in gestational diabetes.

Correlation between Ultrasonographic Findings of Endometrioma and Endometriosis Stage and Recurrence / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate of correlation between ultrasonographic findings of endometrosis and endometriosis stage and recurrence. METHODS: We reviewed medical records of fifty-nine patients who admitted the department of Obstetrics and Gynecology of Sanggye Paik Hospital from April 1998 to June 2004 and were surgically confirmed endometriosis stage 3-4. GnRH agonist was injected every 4 weeks after the first injection following initial operation and a total of six doses were injected to a patient. We performed ultrasonographic examination of pre- and post-operation at an interval of 3 or 6 months. The endometriotic ultrasonographic findings were classified into three group; low-level internal echo (LIE), LIE and septation, LIE and hyperechoic wall foci. The correlation between ultrasonographic finding of endometrioma and endometriosis stage and recurrence were analyzed by Fisher's exact test and Pearson's chi-square test. RESULTS: The follow-up periods after operation were about 11.9 months. Typical ultrasonographic findings of endometrioma were observed on 50 of 59 patients, diagnostic performance of ultrasound in the detection of endometrioma had a 84.7% sensitivity in this study. In 50 cases, 48% (n=24) had a only low-level internal echoes, 32% (n=16) had a low-level internal echoes and multiple septation, 20% (n=10) had a low-level internal echoes and hyperechoic wall foci. The most common ultrasonographic findings were LIE (50%) in stage 3, LIE and septation (33.3%) in stage 4. During follow-up we observed ultrasonographic recurrence in 6 (10.2%) cases. There were no statistically significant correlation between ultrasonographic finding and endometriosis stage or recurrence. CONCLUSION: Ultrasound is a convenient and reliable method for diagnosis of endometrioma. But, it appears that ultrasonographic findings of endometrioma not correlate with endometriosis stage or recurrence. Further long term follow-up studies in large scale is needed for correlation between ultrasonographic findings of endometriosis and clinical significance.

Performance of Risk Indices for Prediction of Osteoporosis in Post- and Perimenopausal women / 대한산부인과학회지

OBJECTIVE: To examine the ability of published osteoporosis risk indices for prediction of osteoporosis in post- and perimenopausal women. METHODS: Subjects included 1559 of post- and perimenopausal women, 45 year old and older, recruited from Menopause Clinic from January 2002 to June 2004. Their bone mineral density (BMD) of femur neck was determined by dual energy x-ray absorptiometry (DXA), and their historical and clinical risk factors were assessed. We employed the World Health Organization (WHO) diagnostic criteria of osteoporosis for calculating the T scores, using race/ethnic and gender-specific young adult mean values. We applied 6 published osteoporosis risk indices (OSTA, ORAI, SCORE, SOFSURF, ABONE, NOF practice guideline) to each subject. Also, the predictive abilities of risk indices were assessed using the area under receiver operating characteristic (ROC) curve. RESULTS: The prevalence of osteoporosis and osteopenia was 8.7% and 32.6% for femur neck, 16.0% and 30.1% for lumbar spine, respectively. The prevalence of osteoporosis for femur neck was increased dramatically in the coming decades (1.6% for fifties, 8.7% for sixties, 43.0% for seventies, 64.1% for over eighties). ROC curve for predicting osteoporosis according to femur neck by OSTA showed the area under the curve (AUC) of 0.920. Sensitivity, specificity, and positive predictive value (PPV) were 93.4%, 75.4%, 26.6%, respectively. AUC for ORAI, SCORE, SOFSURF, ABONE, and NOF practice guideline was 0.896, 0.916, 0.871, 0.846, and 0.856, respectively. CONCLUSION: Validated risk indices have varying complexity, but similar sensitivity, specificity, and PPV for identifying individuals who are likely to have osteoporosis. However, OSTA is the most excellent risk index and simple tool.