Effect of Transforming Growth Factor (TGF)-beta and Peroxisome Proliferator-Activated Receptor (PPAR)-gamma in Endometrial Decidualization / 대한산부인과학회지

OBJECTIVE: To ascertain the expression of transforming growth factor (TGF)-beta receptors in normal human endometrium during the menstrual cycle, and the action of TGF-beta and peroxisome proliferator-activated receptor (PPAR)-gamma during endometrial decidualization using cultured human endometrial stromal cells. METHODS: Human endometrial tissues were examined immunohistochemically for the expression of TGF-beta receptors and Smad. Western blotting, confocal microscopy and viable cell counting were performed on cultured human endometrial stromal cells which were treated with TGF-beta (10 ng/mL) and PPAR-gamma agonists (Rosiglitazone(R) 50 nM). Thereafter we compared the effect of TGF-beta and PPAR-gamma on the Smad phosphorylation, prolactin expression, and cellular proliferation in vitro human endometrial decidualization. RESULTS: The results revealed significantly increased expression of both TGF-beta receptor-I and -II proteins in the secretory stromal cells compared to the epithelial cells of human endometrium. The degree of expression and translocation into the nucleus of the phosphorylated Smad2/3 was also increased in the secretory endometrium compared to the proliferative endometrium. In the stromal cell culture, the decidualization process associated with TGF-beta and pSmad is inhibited by the PPAR-gamma agonist. In contrast to the PPAR-gamma agonist, TGF-beta inhibits cellular proliferation. CONCLUSION: TGF-beta/Smad signaling pathway is essential for endometrial decidualization and closely related to cellular differentiation. PPAR-gamma plays a conflicting role by directly acting on the Smad protein and blocking the TGF-beta/Smad signaling pathway.

Value of laparoscopy in infertile women with normal hysterosalpingograms / 대한산부인과학회지

OBJECTIVE: To evaluate the value of laparoscopy in infertile women with normal hysterosalpingograms. METHODS: Retrospectively analyzed the laparoscopic findings of 79 infertility patients with normal hysterosalpingograms. RESULTS: Of the 79 patients, 28 (35.4%) showed normal laparoscopic findings, while in 51 (64.6%) patients, it was abnormal. Abnormal findings consisted of stage I-II endometriosis in 23 patients (45.1%), stage III-IV endometriosis in 5 (9.8%), peritubal adhesions in 7 (13.7%), and pelvic adhesions in 12 (23.5%). Among patients in whom patent fallopian tubes were demonstrated by hysterosalpingography, there were 2 (4.0%) patients each with tubal obstruction and hydrosalpinx. CONCLUSION: Even in patients who showed normal findings on a hysterosalpingogram, it is thought that laparoscopy in selected cases may provide enhanced efficacy in terms of cost and time effectiveness.

Ultrasonographic Findings as Prognostic Factor in Fetal Ovarian Cysts / 대한산부인과학회지

OBJECTIVE: To investigate whether there was any correlation between sonographic parameters and perinatal course of fetal ovarian cysts. METHODS: This was a retrospective analysis of cases from July, 1994 through February, 2003. The pre- and postnatal data of 10 fetuses who prenatally diagnosed to have an ovarian cyst, delivered and followed up in our obstetric center were analyzed. Maternal age, gestational age of diagnosis, ovarian cyst location, size, combined anomaly, mode of delivery, changes of ultrasonographic parameters, management of ovarian cysts and pathologic findings were reviewed. RESULTS: A total of 10 fetal ovarian cysts were all purely cystic, with well defined margins. Three of 10 cases (30%) showed antenatal sonographic patterns of complicated cysts (2 septa, 1 intraluminal echo) which spontaneously resolved during serial sonographic monitoring. In 2 cases the sonographic findings became complicated postnatally and were operated on revealing dermoid cyst with torsion. Five uncomplicated cysts of 10 cases were spontaneously resolved during perinatal follow-up. In eight cases of ovarian cysts larger than 4 cm, there was only one case which required postnatal surgery. CONCLUSION: There was no single ultrasonographic parameter (internal echoes, septum, character, size) to predict perinatal course of ovarian cysts including spontaneous resolution, torsion and need of operation.

Perinatal Prognosis in Cystic Hygroma According to the Presence of Septation / 대한산부인과학회잡지

OBJECTIVE: We evaluated the association between perinatal prognosis and the presence of septation in cystic hygroma deteted by antenatal ultrasonography. METHODS: During a 5-year period, 65 cases of cystic hygroma were diagnosed by antenatal ultrasonography. 31 cases were included in this study. Fetal karyotyping, hydrops, and associated anomalies were compared between septated and non-septated groups. Statistical analysis was performed using Fisher exact test. RESULTS: There were 24 cases of septated cystic hygromas, and 7 cases of nonseptated cystic hygromas. Sixty-three percent of the septated cystic hygromas had accompanying hydrops and other anomalies (15/24), versus 28% (2/7) in the nonseptated group (p=0.022). Other anomalies such as cleft lip and palate, omphalocele, and club foot were more frequently seen in the septated group. Nine of 14 cases of septated cystic hygroma that underwent karyotying showed aneuploidy (64%), compared with 0% (0 of 6 cases) aneuploidy rate in the nonseptated cystic hygroma group (p=0.014). CONCLUSION: Abnormal fetal karyotyping, hydrops, and other anomalies are more likely to be associated in fetuses with septated cystic hygroma. So, the presence of septation may be the useful prognostic indicator of cystic hygroma.

Propriety and Efficacy of Postoperative Adjuvant Concurrent Chemoradiotherapy for High Risk Group Early Stage Cervical Ccancer Patients Following Radical Hysterectomy and Pelvic Lymph Node Dissection / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). RESULTS: Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). CONCLUSION: This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.