Gene Expression Profiles of Uterine Normal Myometrium and Leiomyoma and Their Estrogen Responsiveness In Vitro

BACKGROUND: Uterine leiomyomas are common benign smooth muscle tumors among the reproductive aged-women. The research has been aimed to identify the differentially expressed genes between normal myometrium and leiomyoma and to investigate the effects of E2 on their expression. METHODS: Gene microarray analysis was performed to identify the differentially expressed genes between normal myomerium and leiomyoma. The data was confirmed at protein level by tissue microarray. RESULTS: Gene microarray analysis revealed 792 upregulated genes in leiomyoma. Four genes (tropomyosin 4 [TPM4], collagen, type IV, alpha 2 [COL4alpha2], insulin-like growth factor binding protein 5 [IGFBP5], tripartite motif-containing 28 [TRIM28]) showed the most dramatic upregulation in all leiomyoma samples. Tissue microarray analyses of 262 sample pairs showed significantly elevated expression of TPM4, IGFBP5, estrogen receptor-alpha, and progesterone receptor (PR) protein in leiomyoma from the patients in their forties, COL4alpha2 in the forties and fifties age-groups, and TRIM28 in the thirties age-group. PR, insulin-like growth factor 1 (IGF-1), IGF-1 receptor (IGF-1R) and IGFBP5 were induced by E2 in in vitro culture of tissue explants from which cells migrated throughout the plate. Among these, PR, IGF-1, IGFBP5 genes showed higher expression in tissue compared to cells-derived from tissue in leiomyoma and IGF-1R in leiomyoma cell. CONCLUSIONS: This observation implies the importance of the whole tissue context including the cells-derived from tissue in the research for the understanding of molecular mechanism of leiomyoma. Here, we report higher expression of TRIM28 in leiomyoma for the first time and identify E2-responsive genes that may have important roles in leiomyoma development.

A Case of Osteogenesis Imperfecta Type II Misdiagnosed as a Camptomelic Syndrome in Uterus / 대한주산의학회잡지

Osteogenesis imperfecta is a very rare heterogeneous disorder and its overall incidence is estimated at 1/25,000 births. It is characterized by bone fragility, loss of bone mass, blue sclera, impaired hearing, poor dentition and hypermobile joints. It is categorized into 4 types and we should distinguish it from other skeletal disorder such as the Camptomelic syndrome. We recently experienced a case of osteogenesis imperfecta type II, misdiagnosed as the Camptomelic syndrome in uterus by ultrasonogram and delivered by Cesarean section near term. We report this case with a brief review of the literature.

A case of atypical polypoid adenomyoma of the uterus in a postmenopausal woman / 부인종양

Atypical polypoid adenomyoma of the uterus is a rare tumor and usually occurs in young women. The most common symptom is abnomal uterine bleeding and the definite diagnosis of the lesions depends on microscopic features. The treatment of this tumor depends on the age of the patient, her desire to retain reproductive function, and the severity of her symptoms. If the patient desires to preserve her reproductive capacity, repeated dilatations and curettages must be done because of the possibility of coexisting endometrial carcinoma. If not, hysterectomy is acceptable. We experienced a rare case of atypical polypoid adenomyoma of the uterus in a postmenopausal woman and report it with brief review of literature.

A Case of Partial Hydatidiform Mole with a Coexistent Live Fetus / 대한산부인과학회지

Hydatidiform moles are generally separated into two classifications. Complete hydatidiform moles are characterized by cystic swelling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin, and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplsia, a fetus or indication of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. Due to advances in cytogenetics and ultrasonography, now permit the diagnosis of this pregnancy antenatally. However this unusual pregnancy has the risks of malignant change and severe medical complications, so it is a dilemma to decide continuation or termination of pregnancy. We experienced a case of partial hydatidiform mole with coexistent live fetus, which was diagnosed by ultrasonography at 12 gestational weeks, and confirmed normal karyotype (diploid) of the coexistent fetus. A brief reviews of related literature was done.

Two Cases of Vesicouterine Fistula after Delivery in Women with Previous Cesarean Section / 대한산부인과학회지

Vesicouterine fistula, a fistula between bladder and uterus, is one of the rarest urogenital fistula. Most cases are associated with repeat Cesarean section and with vaginal birth after Cesarean section (VBAC). During Cesarean section, it is important to dissect and move the bladder away from uterus carefully, especially in case of adherent bladder to the anterior vaginal wall or lower segment wall and it is necessary to explain the possibility of vesicouterine fistula development in case of VBAC. Patients usually present with urinary incontinence in the early postoperative period or present months or years later with cyclic hematuria, amenorrhea, vaginal leakage of urine, urinary tract infection and secondary infertility. The diagnosis is made by cystoscopic visualization of the fistula orifice in the bladder and outlining the fistula tract on cystogram, hysterosalpingogram or transvaginal ultrasonogram. There have been varied approaches to the treatment of vesicouterine fistula with conservative therapy or surgical therapy. We experienced two cases of vesicouterine fistulas in women with previous Cesarean section, the one is delivered with repeat Cesarean section after trying VBAC, the other is delivered with vacuum assisted VBAC, and treated with surgical repair.

Clinical analysis of the perinatal pubic bone separation / 대한산부인과학회지

OBJECTIVE: To raise recognition and find out clinical characteristics about pubic bone separation relatively rarely reported. METHODS: Among the total of 40,475 mothers who had delivered livebirths of over 25 weeks gestation between January 1995 and December 2002, we assigned 40,401 mothers without pubic bone separation to control group I and 74 mothers with pubic bone separation to sample group I. We compared maternal age, gestational age, birth weight and parity between the two groups. To conduct subgroup analysis on mothers who had undergone normal vaginal delivery, we randomly selected 37 out of sample group I and assigned them to sample group II. We selected 1,073 out of control group I with a ratio of nullipara-to-multipara and assigned them to control group II. In subgroup analysis, we compared several risk factors between control group II and sample group II. Lastly, clinical characteristics of sample group I were analyzed by Student's T-test, chi-square test. RESULTS: There were no significant differences in maternal age, gestational age, birth weight and parity between control group I and sample group I. Moreover, there were no significant differences in maternal age, gestational age, parity, weight gain, duration of oxytocin use, BPD and labor duration between control group II and sample group II. But, the history of vacuum delivery, macrosomia and long second-stage labor duration were more notable in sample group II than control group II. The severity and distance of pubic bone separation were severe in cases of normal vaginal delivery than those of Cesarean section. CONCLUSION: In conclusion, it will enhance the diagnostic rate for pubic bone separation in perinatal period to widen the understanding of it's clinical characteristics.

A Case of Normal Vaginal Delivery in a Hyperprolactinemia Patient with Pituitary Macroadenoma / 대한산부인과학회지

Prolactin-secreting adenomas are the most common pituitary tumors resulting in hyperprolactinemia which is one of the most important causes of female infertility with amenorrhea or galactorrhea. Although it is reported that spontaneous pregnancy occured in these patients using bromocriptine treatment or ovulation induction, it is very rare to find a pituitary tumor during a pregnancy by having neurological symptoms of headache, diplopia or visual disturbance. We experienced a case of normal delivery after symptom improvement and maintenance of pregnancy by administration of bromocriptine in a 27 year-old primigravida with diplopia and visual disturbance due to prolactin-secreting pituitary macroadenoma, which is diagnosed by brain MRI scan and serum prolactin level. A brief review of related literature was done.

Long-term analysis of reconstructed temporomandibular joint and mandible using free fibular flap

PURPOSE OF STUDY: The temporomandibular joint (TMJ) occupies a key functional role in mastication and contributes to normal deglutition, speech as well as cosmesis. When a large amount of mandible including the condyle head is resected, it is very difficult to reconstruct it as a functional unit. In this retrospective study, we present the functional, radiographic and cosmetic results of reconstructed temporomandibular joint using free fibular flap. PATIENTS AND METHODS: Total 12 patients (M:F = 6:6) who underwent condylar reconstruction with the fibular flap were interviewed and examined by radiographs and Bio-PAK(R). Mean follow up periods was 47.7+/-20.0 months and the average age was 38.7+/-15.3 years. Remodeling of condyle and function of TMJ were evaluated and facial contour was judged subjectively. RESULTS: All flaps were viable and no immediate postoperative complication had happened. One patient showed decreased mouth opening, so interpositional gap arthroplasty was performed. The resorption rates of reconstructed fibular were minimal and the condyle heads were changed into domeshaped neocondyle after 2 years. All patients had normal diet and no speech difficulty was reported. Nine patients were satisfied with their facial contour but three patients complained about the depression of cheek. CONCLUSION: The reconstruction of TMJ with free fibular flap was reliable methods and very effective means of restoring mandibular function. The functional and morphologic results were excellent and showed little complications.

Diagnosis and Management of Pregnancies Implanted into the Lower Uterine Segment Cesarean Section Scar / 대한산부인과학회잡지

OBJECTIVE: To describe diagnosis and management of Cesarean section scar pregnancy increased at recently due to high Cesarean section rate. METHODS: Eleven cases of pregnancies implanted into the lower uterine segment Cesarean section scar were diagnosed and treated at Daegu Fatima hospital during January 1999 to May 2004. All cases are confirmed by transvaginal ultrasound scan. The management of Cesarean section scar pregnancies included transvaginal evacuation, hysterotomy and medical treatment with methotrexate systemic or local injection into gestational sac. RESULTS: Eleven Cesarean section scar pregnancies were diagnosed. Medical treatment was used in nine women and four women was successful. The success rate were 44% (4/9). Surgical treatment was used in two women included transvaginal evacuation and hysterotomy. Seven women (63%) required blood transfusion and one women (9%) had a hysterectomy. CONCLUSION: Cesarean section scar pregnancies are more common. When the diagnosis is made in early pregnancy the prognosis is good and prevent late pregnancy complication include placenta previa, placental accreta and uterine rupture. The risk of hystrectomy is relatively low.

Aggressive Angiomyxoma at Ischiorectal Fossa / 대한산부인과학회잡지

Aggressive angiomyxoma is a rare soft tissue tumor associated with high risk of local recurrence but lacks metastatic potential. This tumor arise from soft tissue of the perineum or lower pelvis, and affect predominantly yonug women. Aggressive angiomyxoma should be distinguished from more common benign and malignant tumor or tumor like conditions of the pelvic soft part. We report a case of an ususual angiomyxoma in ischiorectal fossa with a brief review of the literature.

Usefulness of Phosphorylated Insulin-like Growth Factor Binding Protein-1 for Prediction of Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate whether the presence of phIGFBP-1 in cervical secretion of patients with symptoms suggestive of preterm labor predicts preterm delivery. METHODS: Patients who were examined at the Department of Obstetrics and Gynecology, Daegu Fatima hospital between 24 weeks' and 34 weeks' gestation with intact membrane, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilatation or=10 microgram/L. Tocolysis and corticosteroids were used when clinically indicated after specimen collection. RESULTS: phIGFBP-1 was detected in 21 patients among 50 patients analysis. Compared with patients who had negative results, patients who had positive results for phIGFBP-1 were more likely to deliver before 37 weeks (p<0.001), before 34 weeks (p=0.008) and within 7 days (p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value were 77.3%, 85.7%, 81.0%, and 8.28%. Patients with positive results were also treated more with tocolysis and corticosteroids use than patients with negative results. Gestational age at delivery (p<0.001) and birthweight (p<0.001) were lower for patients with positive results. CONCLUSION: In a population of patients with symptoms, the presence of phIGFBP-1 in cervical secretions defines a subgroup at increased risk for preterm delivery.

A case of Wernicke-Korsakoff syndrome associated with severe hyperemesis gravidarum / 대한산부인과학회잡지

Hypermesis gravidarum is a complication defined as vomiting severe enough to require hospital admission during early pregnancy. Thiamine deficiency is known to lead to certain neurological seguelae including Wernicke-Korsakoff syndrome. Wernicke's encephalopathy is an illness of acute onset characterized by global confusion, paralysis of eye ball movements, and gate ataxia due to a deficiency of thiamine. The immediate administration of thiamine prevents progression of the disease and reverses brain lesions that have not yet progressed to the point of fixed structural change. We have experienced a case of Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum, which seemed to be developed by prolonged thiamine-free fluid therapy. We emphasize the need for thiamine supplementation in hyperemesis gravidarum patients.

Study on Method of Sperm Aspiration and Injection into an Oocyte in Intracytoplasmic Sperm Injection(ICSI) / 대한산부인과학회잡지

No abstract available.

Detection of Cytokine Gene Expression in Ovarian Cancer Tissues / 대한부인종양콜포스코피학회잡지

The variable clinical responses seen with rnost cancer immunotherapy suggests that there is a large interindividual variation in immunoiogic response to tumors. One of the key functional parameter.s of an immune response is the loca1 production of cytokines. These multifunctional cytokines have been implicated in growth stimulation and cytotoxicity of ovarian tumor celle. To determine the presence and quantities of cytokines in ovarian cancer tissue, the cons-titutive expression of cytokine mRNA in biopsies from epithelial ovarian carcinomas was determined by using a PCR-assisted mRNA amplification asssy(RT-PCR). Using a set of cytokine-specific primers for 14 different cytokines, distinctive patterns of cytokine gene expression between normal and malignant ovarian tissues could be found. Several cytokines were detected even in the norma1 ovarian tissue including IL-1A, IL-8, TGF-A, TGF-B, GM-CSF, and IL,-2R. In case of the ovarian cancer, the signals were more intense than normal and we could detect the expression of some other cytokines, such as IL-1B, IL- 4, IL-6, IL-l0, TNF, and INF-T, which could not be detected in normal tissue. The presence of eytokines in ovarian cancer tissue could be impartant in the growth and development of cancer, more specifically, in relation to host immune responsiveness.