Different expression of GSK3β and pS9GSK3β depending on phenotype of cervical cancer: possible association of GSK3β with squamous cell carcinoma and pS9GSK3β with adenocarcinoma

OBJECTIVE: This study aimed to analyze the expression pattern of glycogen synthase kinase 3β (GSK3β) and its phosphorylated forms, GSK3β phosphorylated at Ser9 (pS9GSK3β), and GSK3β phosphorylated at Tyr216 (pY216GSK3β), in cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC). METHODS: We performed immunohistochemical staining for GSK3β, pS9GSK3β, and pY216GSK3β in 64 SCC and 20 AC cases and compared their expression patterns between the 2 tumor types. RESULTS: Increased GSK3β and pS9GSK3β expression but decreased pY216GSK3β expression compared with that in the normal cervix were observed in both SCC and AC specimens. Specifically, the levels of GSK3β and pS9GSK3β were significantly increased in SCC and AC, respectively. GSK3β was localized in the nucleus and/or cytoplasm of SCC and AC cells. However, pS9GSK3β was predominantly localized in the membrane of AC cells, whereas it was present in the nucleus and/or cytoplasm of SCC cells. CONCLUSION: The results suggest that the phosphorylation status of GSK3β changes during cervical cancer development and the different expression levels and patterns of GSK3β and pS9GSK3β are associated with the specific histologic phenotype of cervical cancer.

Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study

OBJECTIVE: The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). METHODS: We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. RESULTS: Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. CONCLUSION: NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.

Glycogen synthase kinase 3β and cyclin D1 expression in cervical carcinogenesis

OBJECTIVE: Glycogen synthase kinase 3β (GSK3β) is a pluripotent protein kinase involved in the development of cancers through regulation of numerous oncogenic molecules. Cyclin D1, an important regulator of G1 to S phase transition in various cells, is one of target proteins that GSK3β regulate. Our objective was to assess the expression of GSK3β and cyclin D1 in cervical neoplasm of different histologic grades and to identify their correlation in cervical carcinogenesis. METHODS: Immunohistochemical analysis of GSK3β and cyclin D1 was performed in a total of 137 patients with 12 normal, 62 cervical intraepithelial neoplasia (CIN) (31 CIN1 and 31 CIN3) and 63 invasive cancers including 56 squamous cell carcinomas and 7 adenocarcinomas. RESULTS: The expression of GSK3β increased in parallel with the lesion grade, while that of cyclin D1 decreased with severity of the lesion (P<0.001). There was a significant inverse correlation between GSK3β and cyclin D1 expression in overall cervical neoplasia (Φ=-0.413, P<0.001). GSK3β expression was higher in squamous cell carcinoma than in adenocarcinoma (P=0.049). CONCLUSION: These results suggest that the expressional increase in GSK3β plays a role in cervical carcinogenesis and has inverse correlation with cyclin D1 expression in this process. In addition, GSK3β expression appears to be associated with the histologic type of cervical cancer, especially squamous cell carcinoma.

Successful Pregnancy in a Patient with Autosomal Dominant Polycystic Kidney Disease on Long-Term Hemodialysis

Recent advances in dialysis and a multidisciplinary approach to pregnant patients with advanced chronic kidney disease provide a better outcome. A 38-yr-old female with autosomal dominant polycystic kidney disease (ADPKD) became pregnant. She was undergoing hemodialysis (HD) and her kidneys were massively enlarged, posing a risk of intrauterine fetal growth restriction. By means of intensive HD and optimal management of anemia, pregnancy was successfully maintained until vaginal delivery at 34.5 weeks of gestation. We discuss the special considerations involved in managing our patient with regard to the underlying ADPKD and its influence on pregnancy.

Spindle Cell Rhabdomyosacoma of Uterus: A Case Study

Uterine rhabdomyosarcoma (RMS) typically presents as a mixed epithelial and mesenchymal tumors. Pure RMSs of the female genital tract are uncommon. Spindle cell variant of RMS is a rare morphologic subtype of embryonal RMS and mostly occurs in the paratesticular region of children. Here, we present a case of uterine spindle cell RMS in a 76-year-old woman. The tumor, 20x15x7 cm in size, was highly necrotic and adherent to the colon and rectum. Tumor cells were mostly spindle-shaped, and isolated rhabdomyoblasts were scattered. Immunohistochemical stains for myoglobin and myo-D1 showed diffuse positivity for tumor cells. The patient died only of disease three months after diagnosis.

Angiographic findings and effect of superselective embolization for early and late postpartum bleeding / 대한산부인과학회지

OBJECTIVE: Treatment of postpartum bleeding with uterine artery embolization has been well-described so far. However, angiographic differences between early and late postpartum bleeding has not been elucidated. The purpose of this study was to evaluate angiographic differences between early and late postpartum bleeding and therapeutic effect of superselective embolization. METHODS: Medical records and angiographic images of 12 patients (7 early and 5 late) with postpartum bleeding were evaluated. Timing of bleeding, mode of delivery, angiographic findings and treatment outcome were primary variables evaluated. RESULTS: Among 12 patients, 11 patients had been successfully treated with superselective embolization. One patient with amniotic fluid embolism and disseminated intravascular coagulation had expired. Among the early postpartum bleeding, uterine atony was found in every patients except post-cesarean hysterectomy cases. Pseudoaneurysm of uterine artery was found in all patients with late postpartum bleeding. CONCLUSION: Superselective embolization is an effective method to control postpartum bleeding. Pseudoaneurysm of uterine artery is a main cause of late postpartum bleeding.

Who is more appropriate to do metabolic control of pregnancy complicated by diabetes?: Comparison of internist and obstetrician / 대한산부인과학회지

OBJECTIVE: To compared obstetric outcomes of pregnancies complicated by diabetes according to the managing department and to consider role of obstetrician and endocrinologist METHODS: A retrospective analysis of 72 pregnant women managed for diabetes during March 2004 to December 2006 was performed. Eighteen women had been managed by obstetricians (Group I) while 54 women had been managed by endocrinologists of internal medicine (Group II) during their pregnancies at Eulji Hospital. None of these patients had multiple pregnancies, abnormal karyotype, or other medical disorders other than diabetes. Pregnancy outcomes were compared between two groups. RESULTS: No difference was found with regard to the age, parity, BMI (body mass index), weight gain during the pregnancy, and the gestational weeks of delivery. There was also no difference in the blood glucose levels after 100 gm OGTT (oral glucose tolerance test) and HbA1C levels in two groups. The neonatal birth weight of group I (2.89+/-0.21 kg) was significantly lower than that of group II (3.38+/-0.08 kg, P=0.040). The 1 min APGAR score, which was corrected by weight through ANCOVA test, was also significantly lower in group I (7.11+/-0.51 vs 8.11+/-0.19, P=0.028). But There was no difference in 5 min APGAR score. The incidence of birth weight over 3.8kg was significantly higher in group II [37/54 (68.5%) vs 1/17 (5.6%), P=0.030]. Neonatal hypoglycemia was also higher in group II (37.0% vs 11.1%, P=0.043). Other neonatal and maternal complications associated with diabetes were not significantly different between two groups. CONCLUSIONS: In medical point of view, obstetrician can effectively manage diabetes during pregnancy as good as internist. Besides, the management by obstetricians may be more economic, less annoying, and can induce more compliance and motivation of the patients.

The Modulation of IL-12 by Phosphodiesterase IV Inhibitor and Subsequent Changes of Th-1, Th-2 Cytokines in Human Endometrial Tissue / 대한산부인과학회잡지

OBJECTIVE: To assess the capability of phosphodiesterase type IV inhibitor (rolipram) to suppress IL-12 in human decidua and the subsequent changes of Th-2 cytokine (IL-10) and Th-1 cytokine (TNF-alpha). METHODS: Decidual tissues of 10 first-trimester pregnant women and 10 first-trimester pregnant women diagnosed as missed abortion were collected by dilatation and currettage. The decidual tissues were treated with rolipram for 6 hours. Protein and mRNA expression in the tissues were analysed by western blotting, immunohistochemistry and reverse transcription-polymerase chain reaction. RESULTS: Rolipram, in the concentration above 1 microgram/ml, could decrease the expression of IL-12p35 (control: 46.37+/-7.38, rolipram: 24.34+/-8.46) and IL-12p40 mRNA (control: 31.7+/-5.8, rolipram: 14.9+/-4.6) and protein (control: 52.4+/-8.9, rolipram: 40.9+/-12.1). However, the expression of IL-10 and TNF-alpha mRNA and protein did not changed by rolipram. There was no difference in the cytokine expression pattern between the decidual tissues of normal pregnancy and missed abortion. CONCLUSION: Rolipram, the phosphodiesterase type IV inhibitor, could induce the decrease of IL-12 in human decidua. In human decidual tissue, unlike other human tissues, the decrease of IL-12 by rolipram did not modulate other Th-1/Th-2 cytokines. Inability of IL-12 to modulate other Th-1/Th-2 cytokines might be related with unique cytokine network in human decidua rather than its small extent of decrease.

Thanatophoric dysplasia in a dizygotic twins conceived by intrauterine insemination / 대한산부인과학회잡지

Twin gestations complicated by a single anomalus fetus present difficulties in obstetric management. It is unclear how the presence of a congenital anomaly in one twin affects its normal sibling. Parents may elect for obstetric management option such as expectant management or selective termination of the anomalous fetus in the hope maximizing the outcome for the normal co-twin. Thanatophoric dysplasia (TD) is the most common type of lethal skeletal dysplasia. Features of the disease are micromelic shortening of the limbs, relative macrocephaly with frontal bossing, flattened vertebrae, disorganized chondrocytes and trabeculae in the growth plates of the long bones, and shortened ribs resulting in a reduced thorax and a bell-shaped abdomen. We experienced a case of TD type I diagnosed in a dizygotic twins by ultrasound at 23 weeks' gestation and reported with concerned literatures.

Clinical Analysis on Emergency Postpartum Hysterectomy / 대한주산의학회잡지

OBJECTIVE: To analyze incidence, indications, risk factors, complications, and neonatal outcomes of emergency postpartum hysterectomies performed at EulJi University Medical Center. METHODS: A retrospective study of all cases of postpartum hysterectomies between May. 1996 and Dec. 2000. was carried out. RESULTS: 37 cases of postpartum hysterectomies during this period were performed, for overall incidnce of 2.3 per 1000 deliveries. Incidence after vaginal delivery and cesarean section was 0.03% and 0.52% respectively. The rate of postpartum hysterectomy increased with increasing age and parity. The main indications were placental disorders(54.1%) including placenta previa and adherent placenta, uterine atony(37.8%), uterine myoma(5.4%) and uterine rupture(2.7%) in order. The relative risk of postpartum hysterectomy according to the risk factors was 97.6(95% confidence interval 52.17-184.06) for placental disorders, 16.3(95% confidence interval 4.94-52.31) for cesarean section and 2.4(95% confidence interval 1.21-4.76) for previous cesarean section. The mean amount of transfuion was 17.1 pints. Although no maternal mortality had occurred, 16 patients(43.2%) had complica-ions including respiratory complication(13.5%), hemorrhagic complication(10.8%), infection(8.1%) and urologic injury(8.1%). Regarding fetal outcome, 2 of 38 infants(1 case, twin) were stillborn (5.3%) and 10 infants(26.3%) were suffered from various illness including prematurity, sepsis, meningitis, and brain hemorrhage. CONCLUSION: The data identifies placental disorders are the leading cause of postpartum hysterectomy. Although postpartum hysterectomy is a necessary life-saving operation, maternal morbidity remained high.

Efficacy of estradiol supplement therapy for patients with thin endometrium in intrauterine insemination cycles / 대한산부인과학회잡지

OBJECTIVE: To evaluate the endometrial response and to compare the pregnancy outcome of estradiol supplement in patients with abnormally thin endometrium who are undergoing IUI. METHODS : From November 1st, 1998 to February 28th, 2001, 914 IUI cycles were studied and which were divided into several groups. In preparatory cycle, all of the patients were prepared with conjugated estrogen. The patients were divided into several groups according to the endometrial thickness (ET). Control I (n=734) was normal control group (ET>or=7 mm). Control II (n=67) was control group with abnormally thin endometrium (ETintrauterine insemination7 mm) without estradiol supplement. Group I (n=65) and group II (n=48) had thin endometrial thickness. However, in preparatory cycle, the endometrial thickness was more than 7 mm in group I and was less than 7 mm in group II. Uterine preparation consisted of 6-8 mg of estradiol valerate. The number of natural cycle was 234 and the hyperstimulation protocol used were clomiphene (n=250), clomiphene/ hMG (n=214), hMG (n=216). RESULTS: The average pregnancy rate in group I was 15.4%. There was no significant difference between control I (21.1%) and group I. The pregnancy rate in control II and group II was significantly decreased (3.0 vs. 6.3%) compared with control I and group I. In control I and group I, average endometrial thickness and pregnancy rate were decreased when clomiphene was used compared with hMG alone. (endometrial thickness control I 8.4 +/- 0.6 vs. 10.0 +/- 0.7 mm, group I 6.9 +/- 0.8 vs. 7.9 +/- 0.7 mm, pregnancy rate control I 14.6 vs. 29.8%, group I 9.1 vs. 31.3%). CONCLUSION: The adequate endometrial thickness is an important prognostic factor for implantation and is achieved with administration of estradiol supplement in patients with abnormally thin endometrium who responded to exogenous estradiol with endometrial thickness up to 7 mm in evaluation cycle.

Clinical Study of Peripartum Cardiomyopathy / 대한주산의학회잡지

No abstract available.

Clinical Analysis of Midtrimester Amniocentesis / 대한주산의학회잡지

No abstract available.

Insulin-like Growth Factor-Binding Protein-1 in Cervical Secretion as a Predictor of Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: The phosphorylated isoforms of insulin-like growth factor-binding protein-1 (IGFBP-1) were produced by the decidua. The aim of this study was to evaluate whether the presence of phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretions of pregnant women with preterm uterine contractions can predict an increased risk of preterm delivery and infectious complications. METHOD: The prospective study of 32 pregnant women who admitted under the diagnosis of preterm labor with intact membrane at gestational age of 24+0 to 36+0 weeks. Phsphorylated IGFBP-1 was qualitatively assayed using immunochromatography in cervical swab samples at the time of admission. The interval between the test and delivery, gestational age, duration of tocolysis, birth weight, CRP, ESR and the presence of neonatal infection were compared between positive and negative groups. RESULTS: There was no differnce in age, obstetric histories and gestational age and Bishop score at the time of admission between two groups. Eight pregnacies out of 13 positive group and two pregnacies out of 19 negative group resulted in preterm birth. The sensitivity and specificity of the phIGFBP-1 test to predict preterm birth were 80.0% and 77.3%, respectively. The mean getational age and interval between the test and delivery were 38.36 weeks and 45.0 days and 35.78 weeks and 35.46 days in negative and positive group respectively. The birth weight of the babies was significantly higher in negative group. The duration of tocolysis was longer in positive group with marginal statistical significance. The CRP, ESR and WBC count were not different. One postpartum sepsis, one neonatal death and one necrotizing enterocolitis were complicated in positive group. CONCLUSION: The presence of phIGFBP-1 is an usful marker to predict preterm birth in case of regular uterine contraction with intact fetal membranes.

Insulin-like Growth Factor-Binding Protein-1 in Cervical Secretion as a Predictor of Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: The phosphorylated isoforms of insulin-like growth factor-binding protein-1 (IGFBP-1) were produced by the decidua. The aim of this study was to evaluate whether the presence of phosphorylated IGFBP-1 (phIGFBP-1) in cervical secretions of pregnant women with preterm uterine contractions can predict an increased risk of preterm delivery and infectious complications. METHOD: The prospective study of 32 pregnant women who admitted under the diagnosis of preterm labor with intact membrane at gestational age of 24+0 to 36+0 weeks. Phsphorylated IGFBP-1 was qualitatively assayed using immunochromatography in cervical swab samples at the time of admission. The interval between the test and delivery, gestational age, duration of tocolysis, birth weight, CRP, ESR and the presence of neonatal infection were compared between positive and negative groups. RESULTS: There was no differnce in age, obstetric histories and gestational age and Bishop score at the time of admission between two groups. Eight pregnacies out of 13 positive group and two pregnacies out of 19 negative group resulted in preterm birth. The sensitivity and specificity of the phIGFBP-1 test to predict preterm birth were 80.0% and 77.3%, respectively. The mean getational age and interval between the test and delivery were 38.36 weeks and 45.0 days and 35.78 weeks and 35.46 days in negative and positive group respectively. The birth weight of the babies was significantly higher in negative group. The duration of tocolysis was longer in positive group with marginal statistical significance. The CRP, ESR and WBC count were not different. One postpartum sepsis, one neonatal death and one necrotizing enterocolitis were complicated in positive group. CONCLUSION: The presence of phIGFBP-1 is an usful marker to predict preterm birth in case of regular uterine contraction with intact fetal membranes.

Establishment of Three Dimensional in-vitro Culture System with Human Endometrial Cells: Induction of Differentiation by Sex Steroid Hormone & Characterization / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to establish three-dimensionally cultured endometrial cell model containing endometrial stromal cell (ESC), endometrial epithelial cell (EEC) and extracellular matrix (ECM) and to compare the morphological and biomolecular expression patterns of this model with mid-luteal endometrium in vivo. MATERIALS AND METHODS: The EEC and ESC was obtained from hysterectomy specimen and cultured separately. The EEC was overlayered in Matrigel layer on ESC embedded in collagen. The model had been cultured for 48 h in DMEM medium containing estrogen and progesterone. The ultrastructure was evaluated by electron microscopy. The expression of integrins, cyclooxygenases and matrix metalloproteinases were examined by immunohistochemistry and zymography. RESULTS: EEC in three-dimensional culture model grew with polarity and tight junction and desmosome between cells were found. The formation of pinopodes was also detected. In three-dimensionally cultured endometrial cell model, the expression of integrin alpha1, alpha4, beta3, MMP-1, -2, -3 and 9 was detected which was not expressed in monolayer culture of EEC, ESC or ESC embedded in collagen. CONCLUSION: The three-dimensionally cultured endometrial cell model possessed the morphological and biomolecular characteristics of in vivo endometrium of implantation period. These characteristics could be achieved by paracrine interactions between ESC and EEC. This model may contribute to the studies of differentiation of endometrium, process of implantation and pathophysiology of implantation-related diseases.

Chromosomal Aberrations in Ovarian Carcinoma Cell Line, SNU - S , Using Chromosome Painting / 대한암학회지

PURPOSE: The characterization of all recognizable chromosomal rearrangements was dis- turbed by technical limitation of conventional cytogenetic methods. Recently, the strong usefullness of generation of chromosome specific painting probes in identification of marker chromosomes has proven. This study was intended to analyze the chromosomal aberrations in human ovarian cancer cell line, SNU-8, by G-banding and multiple paintings. MATERIALS AND METHODS: Human ovarian cancer cell line, SNU-8 was cultured and harvested for cytogenetic analysis. Routine karyotyping was performed. For complete analysis of chromosomal aberrations, human chromosome-specific painting probes were constructed from somatic hybrid cells. The origins of the unidentified marker chromosomes were analyzed by fluorescent in situ hybridization (FISH) with these painting probes. RESULTS: All chromosome alterations were confirmed by the use of multiple chromosome paintings, which also demonstrated a number of additional alterations. SNU-8 had the karyotype 62-69,XXX, + der(1;10)(q10;p10),der(3;18) (q10;p10)X2,-4,+ 5,+ 7,del(9)(q21)X2,-11,-13,-15,-16,der(17;19)(q10;q10) X2, + 20,-22[cp51]. CONCLUSION: The chromosomal aberrations of SNU-8 cell line was effectively analyzed by FISH with these painting probes, and the approach methods of this study can be applied to cytogenetic analysis of chromosomal aberrations in the other cancers.

Clinical analysis of triple marker screening test for fetal Down syndrome in midtrimester of pregnancy-Low sensitivity of triple marker screening test / 대한산부인과학회잡지

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.

Squamous Cell Carcinoma arising in Cystic Teratoma of the Ovary / 대한산부인과학회잡지

The cystic teratoma is the most common germ cell tumors in reproductive age women. The malignant change of cystic teratoma is rare, about 1~2%, and mostly change to squ-amous cell carcinoma. We experienced 4 cases of squamous cell carcinoma arising in cystic teratoma and re- port our cases with a brief review of the literature.

Four Cases of Scar Endometriosis / 대한산부인과학회잡지

Scar endometriosis is one of the rare conditions among the extrapelvic endometriosis, but it often occurs after pelvic operation and episiotomy. Four cases of scar endometriosis following Cesarean section and episiotomy were exp- erienced and treated with complete surgical excision. Therefore we reported these cases with concerned literatures.