The Survey on Korean Menopausal Women's Behavior and Perception of Hormone Therapy / 대한폐경학회지

OBJECTIVES: After Women's Health Initiative (WHI) study had been published, the use of hormone therapy (HT) have been decreasing even though it is the most effective therapy for menopausal symptom. The survey was conducted to investigate Korean menopausal women's perception of HT and behavior when they are treated by HT. METHODS: During 4 weeks from September 2009 to October 2009, total 600 women aged 45~64 participated in the survey by face to face interview. Out of answering women, women who have visited clinic/hospital at least 1 time to treat their menopausal symptom during last 1 year were included. One hundred fifty women for each age group, 45~49, 50~54, 55~59 and 60~64, were recruited in consecutive order. RESULTS: Eighty percent women who have visited clinic/hospital to treat menopausal symptom, visited obstetrics and gynecology. Only 16% of these women were current user, and other 84% of these women had no experience of HT (53%) or stopped therapy (31%). Among current user, only 9% of women have used HT more than 5 years. Eighty percent of current user had used HT less than 2 years. Most distressing menopausal symptom is 'hot flush' regardless HT experience. When doctor recommend HT, 72% of patients accept HT in overall. Among women who had no experience of HT, the most common reason of not to take HT was concern of side effects (51%). And 67% of women who had concern of side effects worried about cancer incidence. CONCLUSION: Many women with menopausal symptom do not take HT even though it is the most effective therapy. Most of women who take HT stop treatment within 1 year. Most common reason of not to take HT is concern about side effect, increasing incidence of cancer related to HT. Therefore, HT should be considered to short-term relief of menopausal symptoms and at the minimal dose, if possible.

Ectopic ovary with a mature cystic teratoma diagnosed by laparoscopy: A case report / 대한산부인과학회지

The ectopic ovary is a rarely reported gynecologic entity. A variety of synonymous terms have been used to describe this condition, such as supernumerary ovary, accessory ovary, and ovarian implant syndrome. The etiology of ectopic ovary is poorly understood. The ectopic ovaries may occur in two ways. First, in the embryonic theories, they are believed to result from abnormal separation of a small portion of the developing and migrating ovarian primordium. Second, the accessory ovary can occur from acquired conditions such as inflammation and operations. In this report, we describe a case of the ectopic ovary with a mature cystic teratoma autoamputated into the cul-de-sac and subsequently diagnosed by laparoscopy.

A case of unrecognized foreign body in vagina presenting with chronic lower abdominal pain in 20-year-old patient / 대한산부인과학회지

The foreign bodies in vagina cause intense inflammation. Genital complaints in patients could indicate the presence of a vaginal foreign object. Vaginal bleeding and blood-stained, foul-smelling discharge are considered to be the main clinical manifestations of vaginal foreign bodies, and toilet tissue reported as the most commonly found foreign body. The insertion of foreign bodies into the vagina is not uncommon but presentation as lower abdominal pain in an gynaecological clinic is rare. The causes of insertion are sexual stimulation, sexual abuse, accident of post-surgery and most cases find a solution after vaginal speculum examination. We describe a case of foreign body in the vagina of a patient presenting with chronic lower abdominal pain but undetectable and unrecognized in general examination.

Comparison of the Effects of Hormone Replacement Therapy on Bone Mineral Density, Lipid Profiles, and Biochemical Markers of Bone Metabolism / 대한폐경학회지

OBJECTIVES: To assess the effects of hormone replacement therapy on bone mineral density (BMD), biochemical markers of bone turnover, and lipid profiles in postmenopausal women. METHODS: We retrospectively reviewed the medical records of 199 postmenopausal women who had received care at the Department of Obstetrics and Gynecology of Catholic University Seoul St. Mary's Hospital between January 1994 and December 2008. The patients were divided into the following three groups: group 1 received combined estrogen and progesterone therapy (n = 91); group 2 received estrogen only (n = 65); and group 3 received tibolone (n = 43). We compared the changes in biochemical markers of bone turnover, lipid profiles, and BMD during therapy. RESULTS: The BMD of the lumbar spine increased in groups 1 and 3 by 2.0% and 1.2%, respectively, and the BMD of the total femur increased in groups 1 and 2 by 2.3% and 0.5% from the initial values after 3 years, respectively. However, the BMD of the femoral neck and total femur decreased significantly in group 3 by 4.8% and 1.9%, respectively, 3 years after treatment initiation (P < 0.05). Serum osteocalcin and urinary deoxypyridinoline decreased in all groups 1 year after treatment. In groups 1 and 3, the total cholesterol level decreased and the triglycerides level increased. However, there were no definite changes in the total cholesterol and triglycerides levels in group 2. The high density lipoprotein cholesterol (HDL)-cholesterol level increased in groups 1 and 2, but decreased in group 3. As a result, the BMD of the lumbar spine increased and the total cholesterol level decreased in the combined therapy and tibolone groups. Tibolone had no beneficial effect on the BMD of the femoral neck. CONCLUSION: Our results suggest that each therapy has different effects on BMD, biochemical markers of bone metabolism, and lipid profiles. A prospective study involving a larger group, and considering multiple factors, will be required to obtain more clinically meaningful conclusions.

Comparison of the Effects of Hormone Replacement Therapy on Bone Mineral Density, Lipid Profiles, and Biochemical Markers of Bone Metabolism / 대한폐경학회지

OBJECTIVES: To assess the effects of hormone replacement therapy on bone mineral density (BMD), biochemical markers of bone turnover, and lipid profiles in postmenopausal women. METHODS: We retrospectively reviewed the medical records of 199 postmenopausal women who had received care at the Department of Obstetrics and Gynecology of Catholic University Seoul St. Mary's Hospital between January 1994 and December 2008. The patients were divided into the following three groups: group 1 received combined estrogen and progesterone therapy (n = 91); group 2 received estrogen only (n = 65); and group 3 received tibolone (n = 43). We compared the changes in biochemical markers of bone turnover, lipid profiles, and BMD during therapy. RESULTS: The BMD of the lumbar spine increased in groups 1 and 3 by 2.0% and 1.2%, respectively, and the BMD of the total femur increased in groups 1 and 2 by 2.3% and 0.5% from the initial values after 3 years, respectively. However, the BMD of the femoral neck and total femur decreased significantly in group 3 by 4.8% and 1.9%, respectively, 3 years after treatment initiation (P < 0.05). Serum osteocalcin and urinary deoxypyridinoline decreased in all groups 1 year after treatment. In groups 1 and 3, the total cholesterol level decreased and the triglycerides level increased. However, there were no definite changes in the total cholesterol and triglycerides levels in group 2. The high density lipoprotein cholesterol (HDL)-cholesterol level increased in groups 1 and 2, but decreased in group 3. As a result, the BMD of the lumbar spine increased and the total cholesterol level decreased in the combined therapy and tibolone groups. Tibolone had no beneficial effect on the BMD of the femoral neck. CONCLUSION: Our results suggest that each therapy has different effects on BMD, biochemical markers of bone metabolism, and lipid profiles. A prospective study involving a larger group, and considering multiple factors, will be required to obtain more clinically meaningful conclusions.

Mullerian inhibiting substance as a predictive marker of menopausal transition / 대한산부인과학회지

OBJECTIVE: To identified whether serum Mullerian inhibiting substance (MIS) level may be used as a predictive marker of menopausal transition. METHODS: Serum MIS level was measured in reproductive women (n=87), in menopausal transition women (n=58), and in menopausal women (n=5) by ELISA. And we examined the immunohistochemical staining of the MIS in the ovarian tissues of 15 reproductive, 15 menopausal transition, and 5 menopausal women. RESULTS: 1. In the reproductive women, mean serum MIS level was 1.73+/-1.07 ng/ml. In the menopausal transition women, mean serum MIS level was 0.18+/-0.11 ng/ml. Serum MIS level did not show any significant fluctuation patterns according to follicular development. In menopausal transition women, serum MIS level was significantly lower than that of reproductive women (P<0.001). The cutoff value of serum MIS level for menopausal transition was 0.5 ng/mg. In the menopausal women, serum MIS level was not detected. 2. Serum MIS level was significantly decreased as patient age was increased. 3. In the reproductive group, the immunohistochemical staining demonstrated strong expression of MIS in the granulosa cells of the primary follicles and the growing follicles, but not in corpus luteum, preovulatory mature follicle, atretic follicle, and corpus luteum. In the menopausal transition women, immunohistochemical staining for MIS was observed in the nearly same pattern as that of thereproductive women, but with weaker expression. In the menopausal women, immunohistochemical staining of the MIS was not observed. CONCLUSION: MIS is a good candidate for predictive marker for ovarian aging and perimenopausal transition.

A case of adenofibroma of uterine cervix / 대한산부인과학회지

Adenofibromas of the uterine cervix, which are classified as benign tumors of mixed epithelium and mesenchymal cells, are extremely rare. Most common symptom is usually abnormal genital bleeding. It is very difficult to diagnose preoperatively. Recommended method of treatment is total hysterectomy, because it usually recurs. We experienced a case of adenofibroma of the uterine cervix with increased CA125, so report it with a review of the literature.

Enlarged leiomyoma after myolysis with radiofrequency / 대한산부인과학회지

Radiofrequency myolysis is newly developed method for management of myoma. Patients do not need to under general anesthesia neither admission. It decrease the size of myoma with preserve uterus. But the complication and side effect of radiofrequency myolysis had not been published. We have experienced two cases of increased size of the myoma with secondary degeneration after myolysis, so report that with a brief review of literatures.

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.

IGF-I and -II production during menstrual cycle / 대한산부인과학회지

OBJECTIVE: We designed this study to understand the physiologic effects and secretory pattern of IGF-I and IGF-II in human serum and changes in expression of IGF-I and IGF-II in human ovarian tissues during menstrual cycle, and to know which one is more important on human ovarian function between IGF-I and IGF-II, related to FSH, LH and estradiol. METHODS: IGF-I, IGF-II, FSH, LH and estradiol levels were measured in 80 serum samples by ELISA from normal reproductive women. We also examined the immunohistochemical staining of the IGF-I and IGF-II in the ovarian tissues of 14 normal reproductive women. The mean age was 35.6+/-9.15 years-old, ranged from 20 to 45. The average menstrual cycle was 27 to 29 days. RESULTS: 1. The average serum concentration of IGF-I was 204.43+/-50.92 ng/mL, and that of IGF-II was 1381.56+/-292.56 ng/mL. 2. The regular pattern or relationship on serum IGF-I and IGF-II concentrations were not observed (P=0.19). 3. To cross-correlation of serum concentrations of FSH, LH, estradiol and IGF-I, IGF-II, IGF-II was thought to effect on human ovarian menstrual cycles, affected by action of FSH (P=0.048). 4. In the normal reproductive ovaries, we observed immunohistochemical staining for IGF-I in primary, secondary, mature follicle, corpus luteum and stroma, but not in corpus albicans. 5. In the normal reproductive ovaries, we observed immunohistochemical staining for IGF-II in primary, secondary, mature follicle, and corpus luteum but not in corpus albicans and stroma. 6. Stronger immunohistochemical staining was observed in ovaries for IGF-II, rather than IGF-I. CONCLUSION: IGF-I and IGF-II were produced by ovarian tissues, and participated in ovarian folliculogenesis according to menstrual cycles by paracrine, autocrine functions. IGF-II, rather than IGF-I, was thought to effect greater on human ovarian menstrual cycles, affected by action of FSH.

Conservative management of cervical pregnancy with H2O2 irrigation of cervical canal / 대한산부인과학회지

Prevent vaginal bleeding before and after conservative management of cervical pregnancy is the important part of the treatment. We can choose two methode for the conservative management of cervical pregnancy. One is curettage and bleeding control, and the other is using fetocidal agent. Most frequently used fetocidal agent is methotrexate. But additional treatment would be needed after single dose of MTX, and for multiple dosage of MTX, one should be hospitalized about 7 to 10 days. We have used H2O2 intracervical irrigation through enema syringe for conservative management of cervical pregnancy, which is very useful and has no risk of consequent bleeding. So we report it with brief review of literatures.

Radiofrequency myolysis: New conservative management of myoma / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical efficacy of radiofrequency myolysis which is new developed uterine preserving management of myoma. METHODS: 17 patinets (27 myomas) who done radiofrequency myolysis between Oct. 2004-Dec. 2004 were participated this study. Preoperatively, Hemoglobin and subjective symptoms were checked and size of myoma was checked using ultrasonogram or computed tomogram (CT). Radiofrequency was applied to myoma for 10 to 40 minutes per one. Follow up sonogram or CT were done 7 days, 1 month, 2 month and 3 month after myolysis. RESULTS: Average age of patients was 42.7+/-8.6 (yr) and average size of myoma was 4.9+/-2.3 cm. We followed 27 nodules. After 3 months, reduction of volume was observed 65%, from 30% to 94%. 3 nodule, which was followed only 2 months, reduced by 46%. About subjective symptoms, 80% reduction was reported after 3 months (50-100%). Menorrhagia reduced 91% in average and pressure symptoms reduced 71% in average. No severe complication like bowel injury, bladder injury, infection and pulomonary embolism was not observed. Serious vaginal bleeding was reported for 3 patients, and their hemoglobin decreased from 10.8 mg/dL preoperatively to 8.7 mg/dL postopertively. CONCLUSION: Radiofrequency myolysis decreased myoma 65% in average. No serious complication were reported.

The effect of colpoperineoplasty on female sexual function / 대한산부인과학회지

OBJECTIVE: To evaluate female sexual function after colpoperineoplasty. METHODS: Women who visited regional clinic for colpoperineoplasty from June. 2004-Aug. 2004. filled in FSFI (The Female Sexual Function Index) questionnarie before and 4 months after surgery. Six weeks after surgery, they start pelvic muscle training with HMT 2000 (Korea, electric stimulator). RESULTS: Frequency of coitus, sexual desire, arousal, lubrication and orgasm was increased after colpoperineoplasty. Percentage of patients who had coitus more than once a week increased from 18% to 63%. In sexual desire, about 18% felt sexual arousal more than or about half the time before surgery, but increased to 45% after surgery. In sexual arousal, percentage of who felt sexually aroused during more than half of sexual activity increased from 34% before surgery to 69% after surgery. In Lubrication, percentage of who became lubricated during more than half of sexual activity increased from 44% before surgery to 82% after surgery. Who reached orgasm more than half of sexual activity increased from 29% before surgery to 70%. CONCLUSION: Colpoperineoplasty increased female sexual activity.

Isolated tubal torsion with diagnosed hydrosalpinx / 대한산부인과학회지

Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically before exploration. But once happened, promt surgical intervention may allow for preservation of the tube. Recently we experienced isolated tubal torsion with diagnosed hydrosalpinx, and report it with a brief review of literatures.

Correlation between the duration of labor and leptin concentration in cord blood / 대한산부인과학회지

OBJECTIVE: To evaluate the correlation of level of leptin in cord blood and duration of labor. METHODS: Eighty-four pregnant women who had delivered during Jan. 2004-Jun. 2004. at the delivery unit of St. Mary's Hospital of Catholic University Medical College. We checked the level of leptin in cord blood, total duration of labor (cervix 3 cm-delivery of placenta), age of pregnant women, body weight before pregnancy, body weight before delivery, weight of the baby and placenta, head circumference, abdominal circumference, and height of the baby. Leptin was checked by ELISA. RESULTS: Cord blood leptin was in proportion to one's pregnancy duration (umbilical vein p<0.01, umbilical artery p<0.05), change of body weight (p<0.05), weight of placenta (p<0.01), weight of newborn (umbilical artery p<0.01, umbilical vein p<0.05), baby's abdominal circumference (umbilical vein p<0.01, umbilical artery p<0.05). Leptin was in inverse proportion to head circumference of new born infant in umbilical artery (p<0.01) and in umbilical vein (p<0.05). Level of leptin in umbilical vein was in proportion to duration of labor (p<0.05). When the labor duration exceeded 8 hours, leptin in cord blood decreased suddenly, but within 8 hours, their correlation coefficient showed a strong relationship (p<0.01) between the labor duration and leptin level in cord blood. CONCLUSION: Duration of labor affects the level of leptin in cord blood.

Regulation of the apoptosis on the rat granulosa cell: effects of EGF, TGF-alpha / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effect of the epidermal growth factor (EGF) and the transforming growth factor-alpha (TGF-alpha) on the apoptosis of the rat granulosa cells. METHODS: For this study, granulosa cells were isolated from female rats, and granulosa cells were cultured in the presence or absence of different autocrine/paracrine factors such as EGF and TGF-alpha. In order to investigate the apoptotic process, the number of apoptotic cells were counted using Annexin V staining via flow cytometry. In addition, the expression levels of the Bcl-2, ICE and BAX genes were checked. RESULTS: c-AMP induced apoptosis was inhibited neither by EGF nor by TGF-alpha, but FSH induced apoptosis was inhibited by EGF and TGF-alpha. Both EGF and TGF-alpha decreased the rate of apoptosis in the serum free cultured media in a time dependent manner by inducing survival gene expression such as Bcl-2 and suppressing death gene expression such as ICE and BAX. CONCLUSION: EGF and TGF-alpha can be used to decrease the apoptotic rate of the rat granulosa cells. It is hoped to conduct a similar study on the function of these growth factors in the human granulosa cells, and to use EGF and TGF-alpha for reducing the apoptosis rate of the human granulosa cells in IVF.

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.

Factors Affecting Normal Pubertal Development after bone Marrow Transplantation in Girls / 대한산부인과학회잡지

OBJECTIVE: To evaulate the factors affecting pubertal development after bone marrow transplantation (BMT) in girls. METHODS: We collected data from girls older than 14 on 2003, who had received bone marrow transplantation with or without total body irradiation. We checked their menstrual pattern, onset of menarche, growth rate before and after the transplantation using chart review. RESULTS: 41.6% of girls who took menarche before BMT mensurate regularly and 100% of girls who didn't take menarche before BMT suffered by amenorrhea. Time period from BMT to menarche is 0.6 years in the regular-menstruating group, and 2.14 years in the secndary amenorrhea group. 37.5% of girls who didn't take total body irradiation menstrate regularly, but only 15.3% of girls who took total body irradiation menstrate regularly. 100% of girls who showed decreasing growth rate after BMT diagnosed primary or secondary amenorrhea and 75% of girls showed increasing growth rate after BMT menstrated regularly. CONCLUSION: Ovary is more vulnerable before menarche. Time of menarche, time period between menarche and BMT, and radiation are the most important factors affecting ovarian function after bone marrow transplantation.

Factors Affecting Normal Pubertal Development after bone Marrow Transplantation in Girls / 대한산부인과학회잡지

OBJECTIVE: To evaulate the factors affecting pubertal development after bone marrow transplantation (BMT) in girls. METHODS: We collected data from girls older than 14 on 2003, who had received bone marrow transplantation with or without total body irradiation. We checked their menstrual pattern, onset of menarche, growth rate before and after the transplantation using chart review. RESULTS: 41.6% of girls who took menarche before BMT mensurate regularly and 100% of girls who didn't take menarche before BMT suffered by amenorrhea. Time period from BMT to menarche is 0.6 years in the regular-menstruating group, and 2.14 years in the secndary amenorrhea group. 37.5% of girls who didn't take total body irradiation menstrate regularly, but only 15.3% of girls who took total body irradiation menstrate regularly. 100% of girls who showed decreasing growth rate after BMT diagnosed primary or secondary amenorrhea and 75% of girls showed increasing growth rate after BMT menstrated regularly. CONCLUSION: Ovary is more vulnerable before menarche. Time of menarche, time period between menarche and BMT, and radiation are the most important factors affecting ovarian function after bone marrow transplantation.

Effects of Isoflavone on Surgically Menopaused Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effects of isoflavone intake on estrogen deprivated symptoms in surgically menopaused women. METHODS: Premenopausal women who took total hysterectomy with both adnexectomy were randomized into three groups. One group took conjugated equine estrogen 0.625 mg daily for 12 weeks after surgery, the second group took isoflavone 100 mg #3 daily for 12 weeks after surgery, and the third group took no medication for controlled group. Questionnaires about the acute menopausal symptoms, incontinence score, blood lipid profile, bone turnover marker were checked before and 12 weeks after surgery. RESULTS: Kupperman's index and insentience score were showed less increased rate than control group. Total cholesterol and triglyceride were increased in all groups and HDL cholesterol was increased in estrogen and isoflavone groups. Osteocalcin was decreased in estrogen and isoflavone groups, ICTP was decreased in estrogen group, and increased in the other groups. CONCLUSION: Isoflavone was effective to acute postmenopusal symptoms, urogenital atrophy and bone turnover.