APSP will open the door to global periodontal health

No abstract available.

Smoking Exposure and Placental Vascular Compromise: A Nationwide Population-Based Study in South Korea

PURPOSE: This study aims to investigate the effects of smoking on the development of placenta-associated syndromes, including preeclampsia, abruptio placentae, and placenta previa, which share the common pathophysiology of vascular compromise of the placenta. METHODS: A total of 966,629 pregnancies identified from the Korean National Insurance Claims Database and the National Health Information Database were analyzed from 2010 to 2014. The adjusted odds ratio and attributable risk of smoking for the development of placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, were analyzed. Maternal age, alcohol consumption, exercise habit, and economic status were controlled as confounding variables. A binary logistic regression model was used, and simple and multiple logistic regression analyses were performed. RESULTS: Among 966,629 pregnancies, 11.86% of women were ever smokers. Ever smokers had a higher risk of developing placenta previa (adjusted odds ratio, 1.23; 95% confidence interval [CI], 1.18–1.29; adjusted attributable risk, 18.70%). The adjusted odds ratio of developing placenta-associated syndromes in ever smokers compared to nonsmokers over the age of 35 years with a low economic status was 1.32 (95% CI, 1.18–1.47), with an adjusted attributable risk of 23.95%. CONCLUSION: The risk of developing placenta-associated syndromes, such as preeclampsia, placenta previa, and abruptio placentae, is high in ever smokers. Pregnant ever smokers who are >35 years and belong to the lower one-third of the economic division require special care to prevent the development of placenta-associated syndromes.

Relationship between Body Composition and Bone Mineral Density in Pre- and Post-menopausal Women / 대한폐경학회지

OBJECTIVES: We analyzed the relationship between body composition, metabolic parameters, and lumbar and femur bone mineral density (BMD) in pre-and post-menopausal women. METHODS: Of 394 females who participated in a medical check-up program, anthropometric measurements and fasting glucose levels and lipid profiles were measured. Body composition analysis was performed using the bioimpedence method and the BMD of the lumbar spine, femur neck, trochanter, ward's triangle, and total were measured by dual energy X-ray absorptiometry. RESULTS: The mean age was 49.5 +/- 9.8 years, and among the subjects, 203 (51.5%) were pre-menopausal and 191 (48.5%) were post- menopausal women. Skeletal muscle mass, fat- free mass, lean body mass, and basal metabolic rate had a positive correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The abdominal fat ratio, fat mass, waist circumference, percent fat, and total cholesterol had a negative correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The lean body mass in the legs and trunk, skeletal muscle mass, and fat free mass had a positive correlation with the BMD of the lumbar spine and femur neck, unlike the lean body mass of the arms did not, after adjustment for age and weight in post-menopausal women. CONCLUSION: In pre- and post-menopausal Korean women, body composition, lean body mass, fat -free mass, and skeletal muscle mass were positive correlates, and fat mass and percent fat were negative correlates with the lumbar spine and femur BMD.

A case of unicornuate uterus with noncommunicating rudimentary horn with ipsilateral renal agenesis / 대한산부인과학회지

Rudimentary uterus with ipsilateral renal agenesis is a very rare mullerian duct malformation. The unicornuate uterus is a rare type of the anomalous uteri, which is caused by failure of development of one of the mullerian ducts. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An appropriate and prompt diagnosis and treatment will prevent unnecessary procedures and offer relief of symptoms. We presented a rare case of a unicornuate uterus with a noncommunicating horn, and ipsilateral renal agenesis with a brief review of concerned literatures.

Correction of anterior ridge defect for conventional prosthesis / 대한치주과학회지

PURPOSE: Anterior ridge defect after tooth extraction results in unfavorable appearance. Ridge augmentation procedures should be preceded by careful surgical-prosthetic treatment planning, and various techniques can be used in anterior ridge augmentation. MATERIALS AND METHODS: Three patients showed deformed ridges after tooth extraction. Three different techniques ; onlay-interpositional connective tissue graft; bovine hydroxyapatite graft with free connective tissue graft; bovine hydroxyapatite graft with resorbable collagen membrane following free connective tissue graft; were used for anterior ridge augmentation. RESULT: Soft tissue graft can be used in small amount of ridge defect, hard tissue graft combined with soft tissue graft can be used in large amount of ridge defect. After ridge augmentation, about three months of healing period, augmented tissue was stabilized. The final restoration was initiated after this healing period, and the tissue form was maintained stable. CONCLUSION: Careful diagnosis and surgical-prosthetic treatment planning with joint consultation prior to surgery should be performed in order to attain an optimal esthetic results.

A case report: Metroplasty of a noncommunicated uterine body and cervix due to unknown etiology / 대한산부인과학회지

Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women's obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.

Clinical characteristics of 110 women with uterine anomalies / 대한산부인과학회지

OBJECTIVE: To investigate the clinical characteristics of symptoms, diagnostic procedures, infertility, obstetrical complications, and surgical corrections in women with congenital uterine anomalies. METHODS: Between January 1990 and December 2007, 110 patients diagnosed with uterine anomalies from Kangnam St. Mary's Hospital, the Catholic University of Korea were included in this study. The charts of patients were reviewed retrospectively for uterine anomaly type, clinical symptom, diagnostic workup, fertility, fetal presentation, and uteroplasty. Congenital anomaly was categorized according to classification by the American Fertility Society (1988). RESULTS: Uterine anomaly was noticed in 1 in 752 patients (0.13%) who visited the inpatient department. The diagnosis was made by pelvic ultrasonography and manual examination (45.5%), incidental discovery during Cesarean section (24.5%), and other surgical procedures and salpingography. Most common types of uterine anomaly were bicornuate uterus (42 cases, 38.2%) and uterine didelphys (39 cases, 35.5%). Renal anomaly was accompanied in 21 patients (19.1%), frequently associated with bicornuate uterus and uterine didelphys. Uteroplasty was performed in 26 patients with 9 cases of bicornuate uterus (34.6%) and 8 cases of septate uterus (30.8%). The cases diagnosed incidentally during prenatal ultrasound examination were 35.5%. Other initial symptoms were dysmenorrhea, pelvic pain and habitual abortion. Primary infertility was reported in 3 cases (2.7%) which was fewer than abortion. Primary dysmenorrhea was observed in 2 cases (1.8%). One case of PID (0.9%) and one asymptomatic case were noted. Among 241 pregnancies, there were 46.9% full term birth, 24.34% abortion, 9.5% preterm birth, and 0.83% ectopic pregnancy. Fetal presentations were 16.67% breech and 1.51% transverse lie. Cesarean section rate was 81.3%. CONCLUSIONS: Women with uterine anomaly complain symptoms such as dysmenorrhea and pelvic pain, but most are aymptomatic and diagnosed incidentally. They are frequently accompanied with urologic anomalies and complicated with obstetrical challenges such as preterm labor, habitual abortion, malpresentation, intrauterine growth retardation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss sufficiently with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly.

A case of retroperitoneal leiomyosarcoma presenting as a pelvic mass / 부인종양

The authors report a rare case of retroperitoneal leiomyosarcoma in a 49 year-old woman, with a palpable mass in the left lower abdomen. There is a large neoplasm which was soft and movable, looking a pelvic mass. Abdominal and pelvic CT scan showed a 11.0x9.2x7.5 cm-sized lobulated heterogenous enhancing mass with multifocal necrotic portion near the left ovary. Laparotomy and resection of the mass was performed. Microscopic examination revealed 15 mitoses per 10 high power fields. She was diagnosed as primary leiomyosarcoma originated from the left common iliac vein, stage I (IB). The best treatment of these neoplasms is complete surgical excision, and no therapeutic benefit has been derived from chemotherapy or radiotherapy. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the adjacent structures.

Factors affecting the satisfaction rate of radiofrequency myolysis: 18 months follow up / 대한산부인과학회지

OBJECTIVE: To report 18 months follow up results of radiofrequency myolysis and analysis the factors which effect the success rate of myolysis. METHODS: 153 patients who took radiofrequency myolysis between October 2004.~June 2006 in this hospital were enrolled this retrospective study. Except 14 patients which had incomplete data, total 139 patient's charts were reviewed. Sonographic evaluations were checked after a week, 1 month, 3 months, 6 months, 12 months, and 18 months after myolysis. Questions about complications like vaginal bleeding, abdominal pain, feber and vaginal discharge were asked to patients in every visits. Volume of the myoma were checked via 3D ultrasonography. RESULTS: Reduction rate of the volume of myoma after 18 months were 73% and reoperation rate were 4.3%. Improvement rates of patients symptom were 87% (menorrhagea 95%, dysmenorrheal 75%, pelvic pain 60%) The patients who had myomas sized over 100 ml before treatments showed statistically higher rate of reoperation, and decreased rate of satisfaction. Reoperation rate and reduction rate of myoma showed no difference through pathologic diagnosis. The patients who had initial symptoms showed higher rate of satisfaction after myolysis. Total satisfaction rate were 62%, and no serious complications like bowel injury, bladder injury, sepsis and peritonitis were not reported. CONCLUSION: Satisfaction rate after radiofrequency myolysis was increased in symptomatic leiomyoma especially smaller than 6.5 cm in diameter.

A Case of Placenta Increta Complicating a First Trimester Abortion / 대한주산의학회잡지

Placenta increta is a life threatening complication of pregnancy, causing severe post-curettage bleeding. It is usually presented in the postpartum period with hemorrhage during difficult placental removal. It is especially rare in the 1st and 2nd trimesters, which is not easy to find and diagnose. We have confirmed a case of placenta increta after emergency hysterectomy due to severe vaginal bleeding following the dilatation and curettage during the 1st trimester of her pregnancy. So we report it with a brief case history and review of the concerned literatures.

A case of transverse vaginal septum with modified Garcia technique / 대한산부인과학회지

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.

A Clinical analysis of sonographic and operation findings of peritoneal inclusion cyst / 대한산부인과학회지

OBJECTIVE: The aim of this study is to review 4 years' experience of peritoneal inclusion cysts at Kangnam St. Mary's Hospital. METHODS: A retrospective study of 50 cases of peritoneal inclusion cyst between April 1, 1999 and June 30, 2003 was carried out and then clinical feature, preoperative diagnostic findings, operative findings and recurrence were compared with previous reports. RESULTS: The mean age of patients was 40.2 years old and most of them were premenopausal. The majority (94%) of patients had history of laparotomy and most (70.2%) of them had history of total hysterectomy. The values of tumor makers such as CA125 and CA19-9 were normal in most of the patients. The peritoneal inclusion cysts usually generate on the left side of the pelvic cavity, size of them were often (59.6%) 5 to 10 cm and they usually (65.4%) have septum in ultrasonographic findings. They probably had pelvic adhesion or ovarian cyst with them in operative findings. Most of the recurrence occurred after only adhesiolysis was done. CONCLUSION: Because peritoneal inclusion cyst is benign and uncommon disease, its preoperative diagnosis rate was low. In our experience of 50 cases of peritoneal inclusion cyst, most of the patients have history of laparotomy and were premenopausal. When the ultrasonographic findings of cyst are 5 cm to 10 cm in size and have septum, they are likely to be peritoneal inclusion cyst. Their recurrence might be more common when adhesiolysis only was performed.

A case of spontaneous uterine perforation result from acute gangrenous myometritis in an old woman with IUD for 40 yrs / 대한산부인과학회지

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.

A case of Fitz-Hugh-Curtis syndrome diagnosed by pelvic CT imaging prior to diagnostic laparoscopy / 대한산부인과학회지

Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of PID. It is associated with right upper quadrant pain that likely results from the inflammation of liver capsule and diaphragm. The liver capsule becomes involved with inflammatory exudates that later forms violin string adhesion between two liver capsule and adjacent diaphragm or peritoneum. Previously, Neisseria gonorrhea was thought to be the only etiological agent, but recent studies have reported cases of Fitz-Hugh-Curtis syndrome due to Chlamydia trachomatis infection. 15 to 30 percents of women with PID develop symptom of Fitz-Hugh-Curtis syndrome. It is often mistakenly diagnosed as either pneumonia or acute cholecystitis. Laparoscopy may be the definitive method in diagnosis of Fitz-Hugh-Curtis syndrome. However, we have experienced one cases of Fitz-Hugh-Curtis syndrome, which was diagnosed preoperative by pelvic CT imaging and report with the brief review of the literatures.

The role of ceramidase in murine ovarian granulosa cell death / 대한산부인과학회잡지

OBJECTIVE: One of the models we study is the ovarian granulosa cell (GC), a somatic cell lineage that is critically important for maintenance of the female germ line and many endocrine functions of the ovaries. The objective of this study is to clarify the significance of ceramide and the role of ceramide metabolism in dictating the fate of cells exposed to stress. METHODS: We first treated GC with a C8-ceramide analog or an amine derivative of ceramide that cannot be metabolized by ceramidase (C8-ceramine). Northern blot analysis was performed to evaluate mRNA of acid ceramidease expression regualted by gonadotropin and in situ hybridization was done to identify the mRNA expression of acid ceramidase in ovaries. RESULTS: After 6 hours, C8-ceramide (50 micro M) triggered apoptosis in only 28 +/- 6% of the cells, whereas C8-ceramine (50 micro M) induced apoptosis in all cells (LD50=1 micro M). These data suggested that ceramidase activity is a critical determinant of GC survival. In situ hybridization showed that mRNA of acid ceramidase was highly expressed in GC in growing follicle. mRNA of acid ceramidase was expressed abundantly in granulosa cells and ovaries and its expression was significantly increased by gonadotropin in granulosa cells in in situ hybridization. Forty two hour after gonadotropin treatment, mRNA expression of acid ceramidase in granulosa cells was two fold increased cells comparing with no treatment control in northern blot analysis (P<0.05). In copora lutea, elevated mRNA expression of acid ceramidase was decreased. CONCLUSION: We concluded that GC possess inherently high levels of ceramidase activity, and that ceramidase has important for metabolizing ceramind to maintain GC survival in the ovary.

The Effects of Green Tea Extracts (Polyphenon E, EGCG) in Human Papilloma Virus Positive Cervical Lesion / 대한산부인과학회잡지

OBJECTIVE: We tried to confirm the effects of green tea extracts (polyphenon E, EGCG) in patients with human papilloma virus (HPV) positive cervical lesion. METHODS: We divided 51 HPV positive cervical lesion patients (chronic cervicitis, mild dysplasia, moderate dysplasia and severe dysplasia) into 4 group and 37 patient as placebo control. We applied poly E ointment two times per week (27 patients), poly E ointment plus poly E capsule (8 patients), poly E capsule (6 patients), EGCG capsule (10 patients) 200 mg each for 8 to 12 weeks. RESULTS: Among 27 patients with poly E ointment group, 20 patients responded (74%), such as chronic cervicitis (12/18), mild dysplasia (4/5), moderate dysplasia (2/2) and severe dysplasia (1/2). Among 8 patients with poly E ointment and poly E capsule group, 6 patients responded (75%), 6 patients poly E capsule group responded 3 patients (50%). 10 EGCG capsule patients group responded 6 patients (60%). Overall responsive rate is 69% (35/51) in case of green tea extracted treated group and 10% (4/39) in placebo controlled group (P<0.05). CONCLUSION: The effects of green tea extract in HPV positive cervical lesion were statistically significant (P<0.05). This result suggests that green tea extract has highly potential of new treatment agent for HPV infected cervical lesion.

Relationship Between Adeno-Associated Virus and High Risk Human Papilloma Viruses in Cervical Biopsies Using Microdissection Technique / 대한산부인과학회잡지

OBJECTIVE: Adeno associated virus (AAV) is a human DNA virus and is included in the Parvovirus family. AAV has been detected in cervical tissues as well as cervical cancer cell lines. Previous studies showed that AAV infection has some negative effects on HPV infection and that the cervical cancer cell growth is inhibited by AAV infection. The aim of this study is to determine the prevalence of AAV 2 infection and its possible roles for influencing HPV 16 and 18 infection in Korean women by analyzing adjacent normal, CIN, and invasive cervical cancer tissue samples. METHODS: CIN I (20), CIN II (24), CIN III (25), invasive cervical cancer (23) tissues were investigated by microdissection and PCR analyses using primers of HPV 16, 18 and AAV 2 as well as beta- globin as an internal control. RESULTS: AAV 2 was detected in 57 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 55% (11/20), 95.8% (23/24), 52% (13/25) and 52.2% (12/23), respectively. However, HPV 16 was detected in 14 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 8.3% (2/24), 24% (6/25) and 26.1% (6/23), respectively. HPV 18 was detected in 3 out of 92 cervical lesion biopsies. Among these, mild dysplasia, moderate dysplasia, severe dysplasia and invasive cancer showed 0% (0/20), 4.2% (1/24), 8% (2/25) and 0% (0/23), respectively. In contrast, In 92 perilesional normal biopsies, AAV 2, HPV 16 and HPV 18 were detected to be 57.6% (53/92), 3.3% (3/92) and 0% (0/92), respectively. CONCLUSION: AAV 2 was detected in CIN and invasive cervical cancer biopsies by microdissection and PCR analyses in Korean women. It is difficult to confirm any significant roles of AAV 2 infection for developing cervical cancer. However, we observe that there is some correlation between AAV 2 and HPV infection in the carcinogenesis of cervical cancer. Further research remains to be done to further elucidate AAV 2 infection and its role for HPV infection and cervical cancer.

The Efficacy of Lamellar Body Counts for Prediction of Perinatal Outcome / 대한산부인과학회잡지

OBJECTIVE: This study is aimed to evaluate whether lamellar body count (LBC) in amniotic fluid could be used as a predictor of neonatal morbidity as well as respiratory distress syndrome (RDS) and to determine the value of lamellar body count that maximizes sensitivity and specificity. METHODS: We conducted a prospective clinical outcome study. Amniotic fluid was obtained from 39 pregnant women at various gestational ages (29 to 36 weeks) from March 1, 2002 to February 28, 2003. They delivered within 72 hours of amniocentesis, excluding 6 cases of contaminated amniotic fluid. A LBC was performed on each specimen. The frequencies of RDS, minor and major morbidity of newborn in different LBC cutoff value were analyzed. Statistic analysis was done by Chi-square test. RESULTS: LBCs increased with gestation (r=0.533, p<0.05). The LBC cutoff value that best agreed with RDS (sensitivity 36.4%, specificity 93.8%), minor morbidity (sensitivity 100.0%, specificity 50.0%) and major morbidity (sensitivity 45.5%, specificity 81.3%) was 30,000/ l. CONCLUSION: These results indicate that LBC might be useful as a predictor of neonatal morbidity as well as respiratory distress syndrome.

The prognostic value of serum CA 125 in endometrial cancer / 대한산부인과학회잡지

OBJECTIVE: The prognostic value of serum CA 125 sampled before the staging operation and the right CA 125 cut-off level in endometrial cancer was evaluated. METHODS: Medical charts of 119 endometrial cancer patients diagnosed and surgically treated at the Department of Obstetrics and Gynecology, Yonsei University College of Medicine from March 1995 to March 2001 were reviewed. The prognostic value of CA 125 was evaluated by comparing it to other established prognostic factors of endometrial cancer such as myometrial invasion, cervix extension, tumor size, and grossly invasive disease. Enzyme immunoassay (Elecsys 2010; Roche Ltd., Basel, Switzerland) was used for the measurement of serum CA 125. RESULTS: The level of presurgically taken serum CA 125 level correlated well with the established prognostic factors of endometrial cancer. CA 125 was one of the information that could be obtained prior to the surgical staging for predicting extensive endometrial cancer, and it could be correlated with the 5 year survival. CA 125 > or = 20 U/ml had a higher sensitivity and lower false negative rate in predicting extensive endometrial cancer compared to the conventionally used level of CA 125> or = 35 U/ml. CONCLUSION: CA 125 has a prognostic value in predicting the extensive endometrial cancer needing lymphadenectomy, therefore it might be included in the baseline study of endometrial cancer for predicting the prognosis and individualizing the treatment modality. CA 125> or = 20 U/ml might be considered as the cut-off level in endometrial cancer for a better sensitivity and false negative rate.

Triple marker screening for fetal chromosomal abnormalities in Korean women of advanced maternal age

The purpose of this article is to assess the value of maternal serum triple marker screening of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) for the prenatal diagnosis of fetal chromosomal abnormalities in Korean women of advanced maternal age. Maternal sera were collected from 458 pregnant Korean women aged 35 between 15 and 20 weeks gestation before amniocentesis. A patient- specific second trimester risk for fetal Down's syndrome was calculated using the median values for AFP, hCG, uE3 and maternal age. Twelve fetal chromosomal abnormalities were identified. These included six cases of trisomy 21, one case of 46,XY/47,XY,+21, two cases of trisomy 18, one case of trisomy 13, and two cases of 45, X. A cutoff level of 1:200 detected 85.7% (6/7) of the cases of Down's syndrome and 20% (1/5) of the other aneuploidies, with a 27.3% false positive rate. However, a cutoff level of 1:270 did not result in any gains in detecting Down's syndrome or other aneuploidies at the expense of a false positive rate of 34.3%. Second trimester triple marker testing is an effective screening tool for detecting fetal Down's syndrome in Korean women > or = 35 years old. However, it is not an effective screening tool for non-Down's chromosomal abnormalities.