Complementary Medicine in Gynecology / 한양의대학술지

The use of complementary and alternative medicine (CAM) for health maintenance and disease management has been on a steady rise for more than 10 years. The number of visits to alternative care providers seems to have exceeded the number of visits to primary care providers. Most of these users are women who are frequently making decisions regarding treatment options without the advice of their physicians. The spectrum of CAM is broad and includes methods worthy of integration into our current practics, as well as ineffective or fraudulent practices that should be avoided. The management of many women's health issues can be enhanced by the integration of selected CAM approaches. Important issues of CAM use in the gynecologic field are menstrual disorders such as premenstrual syndrome and dysmenorrhea, Infertility and menopause. The purpose of this article is to provide the clinician with current information of CAM of the above mentioned gynecologic issues and to be helpful in providing benefits to patients with appropriate treatment options.

Ovarian cancer related gene targeting with large circular antisense library / 대한산부인과학회지

OBJECTIVE: The aim of this study is to find out the genes which are related to ovarian cancer cell growth using large circular antisense library. METHODS: Clones for antisense library were uni-directionally sub-cloned into pBS SK (-) vector. LC-antisense molecules were then purified from the culture supernatants of the bacterial competent cells superinfected with M13K07 helper bacteriophages. The LC-antisense library to 240 unigene clone was constructed and utilized in the identification of genes functionally involved in the growth of ovarian cancer cells. RESULTS: The 17 numbers out of the 240 numbers of the antisense library exerted a marked inhibitory effect on the growth of SK-OV 3. CONCLUSION: The putative functional categorization of each gene was then conducted via public databases. These candidates may be used as target genes for drug development or adjuvant of conventional chemotherapeutic drugs.

A case of diastasis of the symphysis pubis accompanying gait disturbance developed before labor pain / 대한산부인과학회지

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.

Effect of prolactin on ovarian tissue-type palsminogen activator and prostaglandin E2 in superovulated rat / 대한산부인과학회지

OBJECTIVE: This study is to analyze the direct effects of hyperprolactinemia, cause of anovulation and infertility, on ovarian function. METHODS: The prepubertal female Sprague-Dawley (SD) rats were obtained and ovulation was induced with PMSG and hCG s.c.. The rats were divided into four groups, which received the following treatments IP : saline 0.2 ml, 150 ug PRL, 300 ug PRL, 300 ug PRL plus 300 ug naloxone. The animals were killed and the oviducts were evaluated for the presence of ova. The ovary were then removed and evaluated under light microscopy. For changes of follicular t-PA and PGE2 concentration after PRL, immature female SD rats were stimulated as described above. At four hours after the hCG injection the rats were killed and the ovaried were removed. Each isolated ovaries were incubated in culture plate containing incubation medium or 300 ng PRL to be tested. And PRL plus gonadotropin in incubation medium was tested because of change of PGE2 concentration. After incubation period, t-PA and PGE2 were measured by EIA. Differences between groups were assessed by two-way ANOVA of variance followed Mann-Whitney U test or Kruskal-Wallis test for multiple comparisons. p<0.05 was considered statistically significant. RESULTS: As result, prolactin transiently suppresses ovulation, especially with its increased concentration not by altering the ovarian morphology. But ovulation inhibition was reversed by naloxone injection. The level of t-PA in control and prolactin-treated group increased steadily in response to human chorionic gonadotropin administration, yet lower in prolactin-treated group. But PGE2 concentration was increased in gonadotropin mixed groups but not affected in prolactin-treated group despite a significant blockade of ovulation. CONCLUSION: Thus, further studies on the effect of high level prolactin on ovulatory function would significantly contribute toward the patient with hyperprolactinemia for managing infertility and maintaining appropriate female reproductive function.

Risk of Cesarean Section Delivery after Induction of Labor at Postterm Pregnancy in Nulliparous Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. METHODS: The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks' gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. RESULTS: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59+/-2.57 in cesarean delivery group and 26.99+/-2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70+/-2.82 and 25.75+/-2.67 kg/m2. GA was 41.36+/-0.27 weeks in cesarean delivery group, whereas 41.20+/-0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31+/-358.22 g and 34.59+/-1.18 cm in cesarean delivery group, compared to 3363.95+/-361.22 g and 34.03+/-1.34 cm in vaginal delivery group. CONCLUSION: The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.

3 Cases of Primary Tubal Cancer Incidentally Diagnosed After Benign Gynecologic Operation / 대한산부인과학회지

We experienced 3 cases of early stage tubal cancer incidentally recognized during the operation and diagnosed pathologically after surgery of the tubo-ovarian abscess, the symptomatic adenomyosis, the myoma with adnexal cyst patients, so we report our cases with a review of the literature.

Perforation of the small bowel by a previously inserted intrauterine contraceptive device / 대한산부인과학회지

Intrauterine contraceptive device (IUD) is the most common contraceptive method in the world, but it exists a little risk of uterine perforation and even more severe risk such as a perforation of intra-abdominal organs. In this case, the patient recognized that the previously inserted IUD was translocated but she was asymptomatic without any management. After insertion of the second IUD, she visited our hospital for lower abdominal pain. The abdominal X-ray finding and transvaginal sonography revealed one translocated IUD in peritoneal cavity and another IUD in intrauterine cavity. Thus, we report a case with the laparoscopic diagnosis of small bowel perforation by a previously inserted IUD and its removal by segmental resection of small bowel after mini-laparotomy, along with the brief review.

Effects of alpha-Tocopherol on Cadmium-Induced Toxicity in Rat Testis and Spermatogenesis

Cadmium is known to exert toxic effects on multiple organs, including the testes. To determine if alpha-tocopherol, an antioxidant, could protect testicular tissues and spermatogenesis from the toxic effects of cadmium, six-week old male Sprague-Dawley rats were randomized to receive cadmium at doses of 0 (control), 1, 2, 4 or 8 mg/kg by the intraperitoneal route (Group A) or alpha-tocopherol for 5 days before being challenged with cadmium (Group B) in an identical dose-dependent manner. When both groups received cadmium at 1 mg/kg, there were no changes in testicular histology relative to controls. When Group A received cadmium at 2 mg/kg, undifferentiated spermatids and dead Sertoli cells increased in the seminiferous tubules while interstitial cells decreased and inflammatory cells increased in the interstitial tissues. On flow cytometric analysis, the numbers of elongated spermatids (M1) and round spermatids (M2) decreased while 2c stage cells (M3, diploid) increased. In contrast, when Group B received cadmium at 2 mg/kg, the histological insults were reduced and the distribution of the germ cell population remained comparable to controls. However, alpha-tocopherol had no protective effects with higher cadmium doses of 4 and 8 mg/kg. These findings indicate that alpha-tocopherol treatment can protect testicular tissue and preserve spermatogenesis from the detrimental effects of cadmium but its effectiveness is dependent on the dose of cadmium exposed.

A Case of Pseudomyxoma Peritonei Associated with Borderline Mucinous Tumor of Both Ovaries and Appendix / 대한산부인과학회잡지

Pseudomyxoma peritonei is a rare condition characterized by mucinous ascites associated with peritoneal and omental implants. This is most commonly originated from mucinous tumor of the ovary or appendix. We have experienced a case of pseudomyxoma peritonei associated with borderline mucinous tumor of both ovaries and appendix. We concluded that the appendix is the primary lesion of pseudomyxoma peritonei by various immunohistochemical stains and therefore reporting this case with the brief review of literatures.

A Clinical Study of Pregnancy and Delivery in Pregnant Women 35 Years and Older / 대한산부인과학회잡지

OBJECTIVE: We studied the effects of the age factor in pregnant women who are over the age of 35 on pregnancy, parturition and verified its usefulness in the future managements of the old aged pregnancy. METHODS: Out of 2,526 mothers who delivered in Dongguk university hospital from April 2000 to June 2003, we selected 183 mothers who aged more than 35 years as a study group, and 150 mothers aged between 25 and 29 years as a control group. We then statistically evaluated and analyzed the two groups. RESULTS: Study group consumed up to 7.24%. Placenta previa, male birth delivery, abnormal presentation, low birth weight, iron deficiency anemia and preterm labor was noted more in the study group. Likewise, preterm delivery, pregnancy induced hypertension and cesarean section rates were significantly high in the study group. CONCLUSION: Pregnancy in old age is currently a rising trend. Whlie they might have the tendency to show prenatal complications, neonatal complication and difficult decision making in delivery method, early detection and treatment of presumable complications by adequate antenatal care and appropriate selection of delivery method can reduce the section rates and obtain relatively successful pregnancy outcome.

Two Cases of Stroke Occurred in Pregnant Women During the Period of Antepartum and Postpartum: A Case of Cerebral Infarction and the other Case of Cerebral Hemorrhage in Pregnant Women Both without any Manifestations of Preeclampsia or Eclampsia / 대한산부인과학회잡지

While maternal mortality rates due to obstetric causes have declined in recent years, maternal mortality rates due to non-obstetric causes have relatively increased. Among these, pregnancy related stroke is significant because it has the worst impact on both mother and the fetus. Stroke is the state of necrosis in brain tissues caused by perfusion disorder in the cerebral blood flow and pregnant or puerperal women are reported to have about 13-fold more risk of stroke compared to non-pregnant women. Pregnancy-related stroke must be differentiated from stroke in elderly patients, because it is different in pathophysiological etiologies and recurrence rates and also diagnostic and therapeutic methods may affect the fetal health status. In this article, we experienced one case of hemorrhagic stroke occurred in a normal pregnant woman with gestational age of 40 weeks and the other case with ischemic stroke in 33 gestational weeks, those both without any manifestation of preeclampsia or eclampsia.

A Case of Congenital Intracranial Immature Teratoma / 대한산부인과학회잡지

Congenital intracranial teratoma is a very rare tumor. We recently experienced a case of massive congenital intracranial teratoma that discovered in a male infant of 28 weeks of gestation. A 33-year old multigravida was observed at 28 weeks gestation for prenatal ultrasound examination and ultrasonography revealed the fetus was severely macrocephalic with marked hydrocephalus. For therapeutic termination, Hysterotomy and fetal cephalocentesis was performed to deliver a stillborn infant. Autopsy revealed a 2,420 g male infant with severe macrocephaly. A multilobulated intracerebral tumor was found a diameter 18 cm involving both cerebral hemisphere. The tumor was considered to have originated in the vicinity of pineal gland and suprasellar region. Microscopic examination showed the characteristic picture of a teratoma. The predominent component is immature neuroepithelium in the form of primitive neural tubules variably mature somatic tissure from other germ cell layers accompany the neuroepithelium. We report a case of congenital intracranial immature teratoma.

Clinical Study for the Feasibility of Total Vaginal Hysterectomy on the Cases with Contraindication / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the feasibility of vaginal hysterectomy on contraindicated cases. MATERIAL AND METHODS: We examined the medical records of 154 patients who underwent vaginal hysterectomy and 139 patients who underwent abdominal hysterectomy from March 1999 to March 2002. Among vaginal hysterectomy group, 77 patients (Group I) were found to have more than one contraindication for vaginal hysterectomy such as large uterus (>280 g), nulliparous or no previous vaginal delivery, and previous pelvic laparotomy. Remaining 77 patients (Group II) had no contraindications for vaginal hysterectomy. These two groups were compared with 139 abdominal hysterectomy patients (Group III) regarding preoperative surgical indication, uterus size, operative time, bleeding volume, hospital stay, pain duration and postoperative complications. RESULTS: 1. The Group II patients were older than the other groups (Group I 45.9 years; Group II 53.4 years; Group III 45.9 years) and had history of higher parity by vaginal delivery (Group I 2.5; Group II 3.5; Group III 2.1). 2. The most common indication of hysterectomy was myoma in Group I (59.7%) and Group III (71.9%) and uterine prolapse in Group II (41.6%). 3. The average bleeding volume during the operation was greater in Group III (308.6 ml) than Group I (123.4 ml) and Group II (116.2 ml)(p<0.01). 4. The operative time was longer in Group III (105.4 min) than the other groups (P<0.01). 5. Hospital stay was shorter in Group I (7.6 days) and II (7.6 days) than Group III (8.8 days)(P<0.01). 6. The pain duration was shorter in Group I (1.53 days) and Group II (1.59 days) than in Group III (2.23 days)(P<0.01). 7. The incidence of postoperative major and minor complications was significantly higher in Group III (38.8%) than the other groups (Group I 24.6%; Group II 19.5%)(P<0.01). CONCLUSION: The vaginal hysterectomy is still safe and effective procedure for the patients who have contraindications such as a large uterus, nulliparity or no previous vaginal delivery and previous laparotomy except the cases with immobility of uterus by severe pelvic adhesion.

A Report of Pelvic Inflammatory Disease in the Region of the Po-Hang / 대한산부인과학회잡지

OBJECTIVE: Pelvic inflammatory disease has been inclining over the years and high prevalence rates in teenagers is an upcoming issue. Our study is to research and analyze the PID patients of a certain region to give a better perspect of the disease for adequate prevention and management. METHODS: From March 1998 to December 2001, we underwent retrospective studies on medical records of 130 admitted PID patients in po-hang Dong-guk university hospital. RESULTS: Our of all gynecologic patients, 14.4% were PID patients. 17.7% of these were teenagers and patients who were in there twenties consumed up to 50.8%. The disease mostly occured within 8 days of the first menstruational day. Common etiology of the disease was unmarried state, using IUD as a contraceptive and previous artificial abortion. CONCLUSION: PID patients who are in their teens or twenties represented 68.5% of all PID patients. PID in younger ages keeps increasing and seems to be a trend. Secondary treatment of the disease is undoubtfully important, but primary prevention such as sexual education and birth control must also be considered.

Expression of cyclin D1, PCNA, RB and p16 associated with G1 cell-cycle in DMBA induced rat ovarian carcinogenesis / 대한산부인과학회잡지

OBJECTIVE: Ovarian cancer is common a gynecologic malignancy and leading cause of death in women being diagnosed with advanced disease. This study was undertaken to investigate the roles of the proteins related to G1 cell cycle in ovarian carcinogenesis. METHODS: The expression of cyclin Dl, p16, RB and PCNA in DMBA (7, 12-dimethylbenzanthracene)-induced ovarian cancer of rats was analyzed by immuno-histochemistry and Western blot. RESULTS: 1. Twenty-nine tumors were induced in 32 ovaries from 16 rats (90.6%) in the experimental group. The average weight of tumor was 3.35+/-0.73 gm and the average size was 1.84+/-0.17 cm in greatest dimension. The histologic types were adenocarcinomas (n=20), squamous cell carcinomas (n=3), sarcoma (n=4) and combined types (n=3). 2. With respect to the cyclin D1 and PCNA labelling index, ovarian cancers showed significantly higher index than normal ovarian surface epithelium. There were no differences among the cancer types. In Western blot analysis, the expression of cyclin Dl in ovarian cancers was higher than that in normal ovarian surface epithelium. 3. With respect to the p16 and RB labelling index, ovarian cancers showed significantly lower index than normal ovarian surface epithelium. There were no differences among the cancer types. In Western blot analysis, the expression of cyclin Dl in ovarian cancers were lower than that in normal ovarian surface epithelium. 4. Positive correlation was shown among cyclin D1, PCNA. RB was negatively correlated with cyclin D1, PCNA. The p16 had no correlation with cyclin D1, PCNA. CONCLUSION: These results suggest that the deregulation of cyclin Dl, p16, RB and PCNA occur in DMBA induced rat ovarian carcinogenesis and result in tumor progression. Further studies are needed to investigate the role and function of cyclin Dl-p16-RB pathway in human ovarian cancer with this animal model.

Analysis of Body Mass Index in 4,966 Patients Undergoing Operations / 대한마취과학회지

BACKGROUND: Obesity is defined as an excess accumulation of body fat. To measure body fat accurately is difficult, but body mass index (BMI, kg/m2) is easily available for routine clinical use. METHODS: A total of 4,966 (male; 2,580, female; 2,386) patients from January to September in 1997 and aged up to 90 years old were studied for BMI. Among these subjects, obstetric patients were excluded in our study. We calculated the BMI as weight (kg) per height squared (m2). The heights and weights of study subjects were obtained from anesthesia records. The BMI was analyzed by 4 different age groups: group 1 (less than 3 years), group 2 (between 3 to 7 years), group 3 (between 8 to 17 years), and group 4 (18 years or more), decade of age, 4 obesity categories according to BMI levels: underweight (less than 18 kg/m2), normal weight (19-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (30 kg/m2 or more), and surgical departments. RESULTS: Mean BMI values of group 1, 2, 3, and 4 were 16.1+/-2.9 kg/m2, 16.2+/-2.4 kg/m2, 19.2+/-3.7 kg/m2 and 23.3+/-4.6 kg/m2 in males and 15.7+/-3.9 kg/m2, 15.8+/-2.7 kg/m2, 19.4+/-3.5 kg/m2 and 23.6+/-3.7 kg/m2 in females, respectively. According to generations, the BMI under teen-age was 16.3+/-2.7 kg/m2 and 14.3+/-2.9 kg/m2 in males and females respectively while it was between 20.4+/-3.3 kg/m2 to 25.0+/-3.6 kg/m2 from 1st to 7th decade patients in both sex. The prevalence of overweight and obesity were nearly zero in group 1 and 2, but males in group 3 had them of 4.6% and 1.4% while 6.9% and 0.8% in females, respectively. In group 4 they were 25.3% and 2.2% in males and 28.8% and 4.8% in females, respectively. Obese patients increased in the order of neurosurgery, gynecology, orthopedic surgery, urology, and general surgery departments. CONCLUSIONS: This study revealed the guidelines of BMI of operating patients. We recognized that the prevalence of overweight and obesity of preschool aged and adolescent patients were nearly zero. Adult patients were the highest at 4th decade in males and 6th decade in females and the obesity rates were 27.4% and 33.6% in males and females, respectively.

Clinical Study of the Duration of CO2 Absorption of ROK and USA-produced Soda Lime and Their Re-use Time after Being Exhausted / 대한마취과학회지

BACKGROUND: In a circle system, gas that is to be reused is cleared of carbon dioxide by passing through a canister containing a chemical CO2 absorbent. In anesthesia textbooks the utilization time of carbon dioxide is nearly always specified to last about 5 hours. The soda lime used was noted to regenerate its efficiency for CO2 absorption after being exhausted. Two different types of soda lime (a ROK product and USA product) were analyzed in patients for their duration of carbon dioxide absorption from the anesthetic closed circle system and re-use time after being exhausted. METHODS: General inhalation anesthesia was performed using a PhysioFlex anesthesia machine. To determine the duration of carbon dioxide absorption by soda lime and the re-use time after being exhausted, twenty seven (ROK; 20 and USA; 7) and fifty (ROK; 22 and USA; 28) adult patients were studied. Duration of CO2 absorption was determined as the time for the inspired CO2 concentration to reach 0.5%. The color change of ethyl violet in soda lime was observed throughout the study. Duration of CO2 absorption was compared by unpaired t-test. Re-use time of each group was analysed by simple regression; p less than 0.05 was considered significant. RESULTS: Duration of CO2 absorption was 2.67 +/- 2.12 hrs for the ROK product and 9.52 +/- 0.68 hrs of USA product, and they were different significantly (P < 0.05). Regression equations of ROK- and USA-products werey (min) = 5.761x + 45.701 (r2 = 0.0438, P = 0.3496, x means day after being exhausted) and y = 0.6x + 33.179 (r2 = 0.0158, P = 0.5233) respectively. A color change of ethyl violet in ROK soda lime was not observed throughout the chemical reaction. CONCLUSIONS: From the above results we suggest that ROK soda lime is not effective yet to use for CO2 absorption in clinical anesthesia. It is marked shorter than that of the USA soda lime. A color change of ethyl violet was not observed throughout the chemical absorption reaction in ROK soda lime. Re-use time of both soda limes were not related with the duration after being exhausted.

A Comparison of Intravaginal Misoprostol and Dinoprostone for Cervical Ripening of the Unfavorable Cervix and Labor Induction at Term Pregnancy / 대한주산의학회잡지

No abstract available.

Two Cases of Squamous Cell Carcinoma of the Ovary Arising in Mature Cystic Teratoma / 대한산부인과학회잡지

Between 1 and 2% of benign cystic teratomas undergo malignant transformation. This occurs most frequently in postmenopausal women, who account for only 10% of benign cystic teratoma. A wide variety of neoplasms arise in the mature tissues of otherwise benign teratomas. Of the malignancies arising in teratomas, squamous carcinoma is the most common (83%) with sarcomas accounting for 7%, adenocarcinoma and carcinoid tumors make up most of the others. The presentation in Stage I disease does not differ from that of benign cystic teratoma, except that ascites is occasionally present. In the more advanced neoplasms, the symptoms are those of epithelial ovarian cancer of the same stage. Differential diagnosis between squamous cell carcinoma and benign mature teratoma is difficult but seems to be related to age, size, serum tumor marker (SCC, CA125, CEA). Prognosis of squamous cell carcinoma in mature cystic teratoma was reported much poorer than other epithelial ovarian cancers In the early stages, treatment is possible through surgical intervention alone, but when advanced, 5 year survival rate shows less than 15 percent. We experienced two cases of squamous cell carcinoma of ovary arising in mature teratoma and present with a brief review of literature.

A Case of Adenomyotic Cyst Within Myometrium Accompanied with Endometriosis / 대한부인종양콜포스코피학회잡지

Adenomyotic cyst is very rare disease, their sizes are mostly lesser 5mm. The intrauterine adenomyotic cyst may arise from progressive expansion of cyst due to progressive menstrual bleeding. Authors experienced a case of large adenomyotic cyst within myometrium occuring in a l9-year-old woman, and who was accompanied with endometriosis. The cyst was about 3 x 3em sized, and had chocolate colored thick viscous contents, We experienced one case of adenomyotic cyst which was thought to be degenerated uterine myoma, so we report the case with a brief review of the concerned literatures.