The Effect of Isoflavone Supplementation on Plasma Biochemical Parameters of Women with Polycystic Ovary Syndrome / 대한불임학회지

OBJECTIVE: This study was performed to evaluate the effect of isoflavone supplementation on hormone levels, lipid profiles and total antioxidant status in patients with polycystic ovary syndrome. METHODS: Total 11 women with polycystic ovary syndrome were supplemented daily with 150mg of isoflavone for 6 months. Blood samples were collected 0, 3, and 6 months after supplement of isoflavone for analysis of LH, FSH, E2, testosterone, free testosterone, SHBG levels, serum lipid profiles, and total antioxidant status (TAS). RESULTS: After 6 months isoflavone supplementation, the hormone levels did not change significantly. Serum lipid profiles did not show any significant change in total cholesterol, LDL-cholesterol, triglyceride, lipoprotein(a), and free fatty acid levels. However, there was significant increase in HDLcholesterol (p<0.05) for 3 months. Total antioxidant status was increased significantly after isoflavone supplementation for 6 months (p<0.05). CONCLUSION: Isoflavone supplementation showed positive effects on the HDL-cholesterol and total antioxidant status. it is implicated that isoflavone supplementation will may have a effect on cardiovascular disease in patients with polycystic ovary syndrome.

Apoptosis and Peripheral Benzodiazepin Receptor (PBR) Expression in Human Granulosa-Luteal Cells by GnRH-agonist / 대한불임학회지

OBJECTIVE: To investigate whether GnRH-agonist (GnRH-Ag) using in IVF-ET affects apoptosis of human granulosa-luteal cells and expression of peripheral benzodiazepine receptor (PBR) protein involved in the apoptosis of the cells. METHODS: Granulosa-luteal cells obtained during oocyte retrieval were cultured and treated with 10(-5) M GnRH-Ag. Apoptosis of the cells by the treatment was confirmed using DNA fragmentation analysis 24 h after culture. The presence of PBR protein within the cells was examined by immunofluorescence staining and the expression of the protein was analyzed by Western blotting. In addition, it was measured for progesterone and nitric oxide (NO) produced by granulosa-luteal cells after GnRH-Ag treatment. To evaluate the relationship between NO production and PBR expression, sodium nitroprusside (SNP) as a NO donor was added in media and investigated the expression of PBR protein by Western blotting. RESULTS: Apoptosis increased in the granulosa-luteal cells 24 h after GnRH-Ag treatment, whereas the expression of PBR protein significantly decreased. Furthermore, the production of progesterone and nitric oxide (NO) by the cells significantly fell from 12 h after the treatment. In the results of Western blotting after SNP treatment, the expression of PBR protein increased in the treatment with SNP alone to the granulosa-luteal cells, but was suppressed in the treatment with GnRH-Ag and SNP. Additionally, the staining result of PBR protein in the cells showed the even distribution of it through the cell. CONCLUSION: These results demonstrate that GnRH-Ag treatment induces apoptosis, decreasing expression of PBR protein and NO production in human granulosa-luteal cells. The present study suggests that one of the apoptosis mechanism of human granulosa-luteal cells by GnRH-Ag might be a signal transduction pathway via NO and PBR.

Cell Cycle Signaling Pathway by Cyclins-CDKs and CDKIs in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the cell cycle signaling pathway by cyclins-cyclin dependent kinases (CDKs) and cyclin dependent kinase inhibitors (CDKIs) in endometriosis. METHODS: 38 women with endometriosis were recruited. Endometrioma and the normal ovarian tissues were obtained during laparoscopic surgery on the follicular phase of menstrual cycle. And then, the normal endometrial tissues were taken by currettage. Nuclear proteins (cyclin D1, cyclin E etc), CDK molecules and CDK inhibitors (p27(kip1), p21 etc) were quantitated on transcriptional and translational levels by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. RESULTS: In RT-PCR analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 of endometrioma and eutopic endometrium was increased, and the expression of p27(kip1) was decreased compared with normal ovary. The mRNA expression of cyclins-CDKs and p27(kip1) was not significantly different between endometrioma and eutopic endometrium. In Western blot analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 was significantly increased and the expression of p27(kip1) was significantly decreased in endometrioma and eutopic endometrium compared with normal ovary. And, the expression of p27(kip1) in endometrioma was further decreased than that of eutopic endometrium. CONCLUSION: These results suggest that p27(kip1) on the translational level, in the cell cycle signaling pathway, was closely related to endometriosis. In future, further experimental studies will be needed for the understanding of the cell cycle signaling pathway in endometriosis.

Cell Cycle Signaling Pathway by Cyclins-CDKs and CDKIs in Endometriosis / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the cell cycle signaling pathway by cyclins-cyclin dependent kinases (CDKs) and cyclin dependent kinase inhibitors (CDKIs) in endometriosis. METHODS: 38 women with endometriosis were recruited. Endometrioma and the normal ovarian tissues were obtained during laparoscopic surgery on the follicular phase of menstrual cycle. And then, the normal endometrial tissues were taken by currettage. Nuclear proteins (cyclin D1, cyclin E etc), CDK molecules and CDK inhibitors (p27(kip1), p21 etc) were quantitated on transcriptional and translational levels by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. RESULTS: In RT-PCR analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 of endometrioma and eutopic endometrium was increased, and the expression of p27(kip1) was decreased compared with normal ovary. The mRNA expression of cyclins-CDKs and p27(kip1) was not significantly different between endometrioma and eutopic endometrium. In Western blot analysis, the expression of cyclin D1-CDK6, cyclin E-CDK2 was significantly increased and the expression of p27(kip1) was significantly decreased in endometrioma and eutopic endometrium compared with normal ovary. And, the expression of p27(kip1) in endometrioma was further decreased than that of eutopic endometrium. CONCLUSION: These results suggest that p27(kip1) on the translational level, in the cell cycle signaling pathway, was closely related to endometriosis. In future, further experimental studies will be needed for the understanding of the cell cycle signaling pathway in endometriosis.

Hysteroscopic Endometrial Ablation as a Treatment of Abnormal Uterine Bleeding in Renal Transplant Patients / 대한산부인과학회잡지

OBJECTIVE: To assess the effectiveness and safety of hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients. METHODS: Data were collected retrospectively from 62 patients referred to Department of Obstetrics and Gynecology, Yonsei University Medical Center from January 1999 to December 2001 for abnormal uterine bleeding with prior history of renal transplantation who subsequently received hysteroscopic endometrial ablation. Hormonal status of these patients were evaluated before the operation by sampling estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), and prolactin. Mean follow-up duration was 6 months. Levonorgestrel-releasing intrauterine system (LNG-IUS)s were inserted in those who experienced recurrent bleeding. RESULTS: Mean age of patients was 34.6+/-6.7 years and mean duration from renal transplant to onset of abnormal uterine bleeding was 4.5+/-2.5 years. All hormone levels (E2, LH, FSH, TSH, prolactin) were within normal range. 54 out of 62 patients (87.0%) who underwent hysteroscopic endometrial ablation reported decreased bleeding: amenorrhea in 25 (40.3%), spotting in 19 (30.6%), and eumenorrhea in 10 (16.1%). None reported complications related to the procedure. LNG-IUSs were inserted into 8 patients who experienced continuous bleeding, 5 out of whom showed symptomatic improvement: spotting in 3 (4.9%) and eumenorrhea in 2 (3.2%). 3 patients in whom LNG-IUS had no effect received total abdominal hysterectomy. CONCLUSION: Hysteroscopic endometrial ablation as a surgical management of abnormal uterine bleeding developed in renal transplant patients is an effective and safe procedure.

The Action Mechanism of Tamoxifen Via Estrogen Receptor on Uterine Leimyoma / 대한불임학회지

OBJECTIVES: To investigate the distribution of ERa, ERb, c-fos and c-jun in the uterine myoma and myometrium in oder to know how the tamoxifen cause the growth of myoma. METHODS: Myoma and myometrial tissue were obtained from the postmenopausal women treated with tamoxifen in the patients with breast cancer and in the premenopausal patients, who were undergoing myoma of uterus from 1998 through 2000. The espression of each gene was quantitated with quantitative RT-PCR. RESULTS: The expression of ERa was slightly increased in the myoma than the myometrium in the proliferative phase, and was slightly decreased in the myometrium than the myoma in the secretory phase. However it was not significant statistically. In the postmemopausal women treated with tamoxifen, ERa was expressed in all myoma and myometrial tissues and the expression was not statistically significant. The expression of ERb was slightly increased in the myometrium than the leiomyoma in the proliferative and secretory phase, but it was not significant statistically. In the postmemopausal women treated with tamoxifen, the expression of ERb was significantly incresed in the myometrium than the leiomyoma. The expression of c-fos was significantly increased in the myometrium than the leiomyoma in the proliferative and secretory phase. In the postmemopausal women treated with tamoxifen, the expression of c-fos was slightly increased in the leiomyoma than the myometrium, however, it was not statistically significant. CONCLUSION: Tamoxifen may cause the growth of leiomyoma by ERa with AP-1 pathway reducing the counteraction of ERb to ERa.

Expression of Steroidogenic Acute regulatory (StAR) Protein during Oocyte Apoptosis in the Gonadotropin-Stimulated Human Ovary / 대한산부인과학회잡지

OBJECTIVE: To determine the distribution and expression of steroid acute regulatory (StAR) protein in human oocyte and embryo in relation to apoptosis. METHODS: Immuno-labelling and confocal microscopy were applied to examine the localization of StAR protein in human oocytes and embryos. Western blot analysis was also used for qualitative and quantitative assessment of StAR protein expression. RESULTS: There were lipid droplet accumulation in fragmented human oocytes and embryos. StAR protein (30 kDa) expression was detected in human oocytes and embryos. The level of StAR protein expression was lower in the fragmented group than the normal group. CONCLUSION: The present study provides evidence for involvement of StAR protein in the apoptosis of fragmented oocytes and embryos during in vitro fertilization (IVF) program as well as in the normal development of human oocytes and embryos.

Endometriosis in an Adolescent Population: the Severance Hospital in Korean Experience

The records of adolescent patients (10-21), who were admitted to the severance hospital between 1990 and 1999, were reviewed retrospectively to evaluate the age distribution, diagnosis, clinical stage, and treatment for endometriosis in adolescents. Thirty-nine patients who had undergone a laparotomy or laparoscopy and were diagnosed with endometriosis were identified. Endometriosis was classified according to the revised American Fertility Society classification (AFS). The chief symptoms leading to the diagnosis, clinical stage, age distribution, and treatment modality were reviewed. All patients, whose average age of menarche was 14.2, were diagnosed with endometriosis with an average interval of 5.9 years after menarche. The chief symptoms leading to the diagnosis were chronic pelvic pain (27%), acute pelvic pain (21%), a palpable pelvic mass (21%), and dysmenorrhea (18%). A laparoscopy was performed in 20 (51%). The majority of patients (44%) presented with the revised AFS classification stage II. Four patients (10%) presented with stage I, 11 (28%) with stage III and 7 (18%) with stage IV. Management after surgery included GnRH agonists (64.1%), expectant managements (25.7%), OCPs (5.1%) and danazol (5.1%). In adolescents with chronic pelvic pain, endometriosis is not rare. Therefore, early referal to a gynecologist to diagnose the etiology of the pelvic pain and initiate appropriate therapy is recommended.

Effect of Hysterectomy on Conserved Ovarian Function

The aim of this study was to assess the impact of premenopausal Total Abdominal Hysterectomy (TAH) on the function of the remaining ovaries by reviewing the menopausal age in TAH treated patients. We retrospectively reviewed the medical records of 510 women who had previously undergone TAH, either with or without unilateral salpingo-oophorectomy, due to benign disease at the department of Obstetrics and Gynecology, Yonsei University College of Medicine, between Jan 1989 and Dec 1992. Out of the 510 women, the 94 who were throughly followed up were included in the study, and their menopausal age based on patient symptoms was compared to that of the control group. The mean menopausal age in TAH treated patients was significantly lower than that of the control group (P < 0.001). There was a positive correlation between age at operation and menopausal age. From this study, we could conclude that TAH accelerated ovarian dysfunction, and that the younger the patient was at the time of operation, the earlier the onset of menopause. It is hence apparent that women treated with TAH are at risk of early menopause and should receive adequate hormone replacement therapy.

Carotid Intima Media Thickness (IMT) in Relation to Subclinical Atherosclerosis in Turner Syndrome / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to determine whether women with Turner syndrome have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. METHODS: 18 Women with Turner syndrome and 18 women as control group were measured the intima media thickness (IMT) of common carotid artery by B-mode ultrasound. We compared the IMT between cases and controls, and analyzed risk factors which affect the IMT. RESULTS: There are no differences between the groups in age and body mass index (BMI). The height was shorter (147.8+/-7.9 vs 160.3+/-5.9, p<0.001) and the waist-hip ratio (WHR) was significantly increased in Turner syndrome (0.86+/-0.04 vs 0.78+/-0.04, p<0.001). Fasting blood sugar (FBS) (90.1+/-9.9 vs 79.4+/-4.4 mg/dl, p<0.001), fasting insulin (9.5+/-3.0 vs 4.7+/-1.0 IU/ml, p=0.009), total cholesterol (187.1+/-21.3 vs 154.8+/-21.8 mg/dl, p=0.014), and LDL (111.3+/-10.0 vs 82.8+/-16.4 mg/dl, p=0.009) were significantly higher in Turner syndrome. Compare to control, the IMT was significantly increased in Turner syndrome (0.61+/-0.09 vs 0.49+/-0.02 mm, p=0.002). In the analysis of correlation between the IMT and clinical & biochemical characteristics, Turner syndrome status, WHR, FBS and fasting insulin were significantly affecting factors (Coefficients of correlation: 0.720, p<0.001; 0.671, P<0.001; 0.445, p=0.020; 0.904, p<0.001). CONCLUSION: These results suggested that women with Turner syndrome might have an increased risk of subclinical atherosclerosis and insulin resistance was most important risk factor.

The Immunologic Expression of Apoptosis Related Proteins and Apoptotic Cells in Human Ovarian Follicles / 대한불임학회지

OBJECTIVE: To investigate the expression of apoptosis related proteins and apoptotic cells on the human ovarian follicles. MATERIALS AND METHODS: Thirty five Formalin-fixed paraffin-embedded human ovarian tissue blocks were selected from the surgical pathology files of the department of pathology, College of Medicine, Yonsei University, for the period from 1996 to 1998. All specimen were from premenopausal women aged from 32~45. Ovarian tissues were collected from the patients performing hysterectomy for benign uterine diseases. Immunohistochemical staining was performed for the detection of DNA fragmented cell, Bcl-2, Bax, Fas and Fas-ligand. RESULTS: Bcl-2 and bax were not expressed on the surrounding cells and oocyte of the primary, primordial and preantral follicles. Fas and Fas-ligand (Fas-L) were not expressed on the surrounding cells on the primordial and primary follicles. But expressed on the surrounding granulosa cells and oocyte in the primordial and primary follicles. In the healthy follicles, Bcl-2 was expressed on the granulosa cells, however, Bax was not expressed. DNA fragmented cells were expressed on the inner granulosa cell layer of atretic follicles. CONCLUSION: Fas, Fas-ligand, and Bax may be responsible for the follicular atresia and Bcl-2 may be involved in the follicular survival in the human ovary.

Intima Media Thickness(IMT) in Relation to Insulin Resistance and Subclinical Atherosclerosis in Polycystic Ovary Syndrome(PCOS) / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study was to determine whether women with PCOS have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. METHODS: Women with PCOS(n=24) and age and body mass index(BMI)-matched cycling women(n=16) as control group underwent carotid scanning for the measurement of the IMT. We compared IMT and plaque between cases and controls, assessed some risk factors for atherosclerosis, and analyzed factors affecting IMT. RESULTS: There was no difference between the groups in waist-hip ratio(WHR) and in the levels of total cholesterol, triglyceride(TG), LDL, Lp(a), fibrinogen, homocystein, plasminogen activator inhibitor 1. However, HDL was significantly lower, and systolic and diastolic blood pressure, fasting blood sugar or insulin concentration and IMT was significantly higher in PCOS group than control group (51.1+/-11.6 vs 60.4+/- 10.0mg/dl, 119.4+/-12.5 vs 109.0+/-11.6mmHg, 79.1+/-11.1 vs 68.9+/-7.8mmHg, 93.6+/-11.1 vs 85.0+/-5.9 mg/dl, 8.9+/-5.2 vs 5.0+/-3.3milliunit/ml, 0.57+/-0.12 vs 0.49+/-0.11mm respectively, all p<.05). In the analysis of correlation between the IMT and clinical characteristics, PCOS status, BMI, systolic and diastolic blood pressure, fasting blood sugar or insulin concentration, TG, HDL, fibrinogen were significantly independent variables (Coefficients of correlation were 0.358, 0.461, 0.452, 0.349, 0.405, 0.466, 0.478, -0.433, 0.349 respectively, all p<.05). The factors affecting IMT by multivariate regression were PCOS status and fasting insulin concentration. CONCLUSIONS: We concluded that women with PCOS might have an increased risk of subclinical atherosclerosis and insulin resistance was assumed to be the main risk factor of atherosclerosis.

Study on endometriosis in an adolescent population / 대한산부인과학회잡지

PURPOSE: To review diagnostic procedure, clinical stage, age distribution, treatment of endometriosis in adolescents. MATERIAL AND METHOD: We retrospectively reviewed medical records of 39 adolescent girls(11-21) admitted to Yonsei University College of Medicine between 1990 and 1999. We identified 39 patients who underwent laparotomy or laparoscopy and was diagnosed as having endometriosis. Endometriosis was classified according to the Revised American Fertility Society Classification(AFS). The chief symptoms leading to diagnosis, clinical stage, age distribution, and treatment modality were reviewed. RESULTS: Average age of menarche was 14.2, and the interval after the menarche was 5.9 years. The chief symptoms leading to diagnosis were chronic pelvic pain(27%), acute pelvic pain(21%), palpable pelvic mass(21%), dysmenorrhea(18%). Laparoscopy was performed in 20 patients(51%). The majority of the patients(44%) presented with stage II, 4(10%) with stage I, 11(28%) with stage III, and 7(18%) with stage IV. GnRH agonists(64.1%), expectant managements(25.7%), OCPs(5.1%) and danazol(5.1%) were used after surgery. CONCLUSION: Adolescents with chronic pelvic pain have a high rate of endometriosis and should be promptly referred to a gynecologist to diagnose the etiological lesion of pelvic pain and initiate appropriate therapy.

Pregnancy Outcomes in Women with Unexplained Elevation of Maternal Serum Human Chorionic Gonadotropin Levels at Midtrimester / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the association between unexplained elevation of maternal serum human chorionic gonadotropin (hCG) in the second trimester and adverse pregnancy outcomes. MATERIAL AND METHODS: Between February 1995 and July 1999, we evaluated 1566 pregnant women who have underwent second trimester triple marker screening tests (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) and delivered at Severance Hospital, Yonsei Medical Center. Multiple pregnancies, abnormal fetal karyotypes, fetal anomalies, and abortions were excluded from the study. One hundred twenty-one women with hCG levels greater than 2.0 multiples of the median (MoM) were included in the study group while 1389 women with hCG levels less than 2.0 MoM served as the control group. Pregnancy outcomes were obtained from the delivery and neonatal records in our institution. Adverse pregnancy outcomes between the two groups were compared using chi-square test and Fisher's exact test. RESULTS: Women with unexplained elevation of human chorionic gonadotropin levels were associated with statistically significant increased risks for preeclampsia, preterm delivery, and low birth weight (p<0.05). However, there were no significant differences between the study and control groups with respect to preterm premature rupture of membranes, abnormal fetal heart rate tracing, abruptio placentae, intrauterine fetal death, and neonatal death. CONCLUSION: An unexplained elevation in human chorionic gonadotropin level in the second trimester may increase the risk for preeclampsia, preterm delivery, and low birth weight but not for other adverse pregnancy outcomes such as preterm premature rupture of membranes, abnormal fetal heart rate tracing, intrauterine fetal death, or neonatal death.

Torsion of the pregnant uterus

A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.

Expression of Estrogen Receptor and Telomerase Activity in Chorionic Villi and Decidua of Early Human Gestation / 대한산부인과학회잡지

OBJECTIVE: To investigate whether there is any differences between normal pregnancy (NP) and spontaneous abortion (SAB) regarding estrogen receptor (ER) expression and telomerase activity (TA) in the chorionic villi and decidual tissues. METHODS: Chorionic villi and decidual tissues were obtained between 6 and 9 weeks' gestation from 14 patients with SAB and 17 normal pregnant women who have undergone an elective abortion. All tissue samples were assayed for ER with enzyme immunoassay and also TA was analysed using telomeric repeat amplication protocol. RESULTS: A significant decrease in ER expression (2.81+/-2.77 fmol/mg of protein; p<.001) was demonstrated in SAB group compared to that of NP group (4.56+/-1.85 fmol/mg) in decidua. However, no significant difference in ER expression in chorionic villi was found between the two groups. SAB group showed significantly lower levels of TA than that of NP group in both chorionic villi (21.4% vs. 82.4%; p=.002) and deciduas (7.1% vs. 52.9%; p=.009). CONCLUSION: Our results suggest that decreased level of ER expression in deciduas might cause decidual senescence and eventually, spontaneous abortion.

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.

Effect of Hysterectomy on conserved Ovarian function / 대한산부인과학회잡지

OBJECTIVE: To assess the impact of premenopausal total abdominal hysterectomy (TAH) on the function of remaining ovaries by reviewing the menopausal age in patients treated with total abdominal hysterectomy. METHODS: We retrospectively reviewed medical records of 510 women previously treated with TAH or TAH with unilateral salpingo-oophorectomy (USO) due to benign disease at the department of Obstetric and Gynecology, Yonsei University College of Medicine, between Jan, 1989 and Dec, 1992. Out of 510 women, 94 women who were thoroughly follwed up were included in the study, and their meopausal age based on patients symptoms were compared to those of the control group. RESULT: Mean menopausal age in patients treated with TAH was 46.3+/-3.0 years and in the normal control group was 49.1+/-3.2 years. The mean age of menopause was significantly lowered in patients treated with TAH/TAH with USO (P< 0.001). There was positive correlation between age at operation and menopausal age. CONCLUSION: According to this study, TAH accelerated ovarian dysfunction, and younger the patient is at the time of operation, earlier the menopause. Therefore, woman treated with TAH is at risk of early menopause and should receive adequate hormone replacement therapy.

A Case with Balanced Chromosome Rearrangement Involving Chromosomes 9, 14, and 13 in a Woman with Recurrent Abortion

A phenotypically normal couple was referred for cytogenetic evaluation due to three consecutive first-trimester spontaneous abortions. Chromosomal analysis from peripheral blood was performed according to standard cytogenetic methods using G-banding technique. The husband's karyotype was normal. The wife's karyotype showed a balanced complex chromosome rearrangement (CCR) involving chromosomes 9,14, and 13. There were three breakpoints: 9p21.2, 14q21, and 13q12.2. The karyotype was designated as 46, XX, t (9;14;13)(p21.2;q21; q12.2). Fluorescence in situ hybridization (FISH) analysis with chromosome-specific libraries of chromosomes 9,14, and 13 was performed to confirm this rare chromosome rearrangement. The result of FISH coincided with that obtained by standard cytogenetic techniques.

A Case of Renal Cell Carcinoma Presented with Chest Wall Metastasis / 결핵

The appearance of a tumor in the chest wall is rare compared to that in any other part of the body. It can be classified into benign and malignant types and can be located in the rib, clavicle, sternum, cartilage and soft tissues. Tumors that are metastatic are commonly located in the lung, breast, bone and pleura. But, the soft tissue mass of anterior chest wall is rarely metastasized from a distant organ that is not confined to the thoracic cavity. This and thus has rarely been described. A 68-year-old man was admitted to our hospital with a chief complaint of resting dyspnea. A huge non-tender mass of about 10*15 cm in size was visible on his left lower anterior chest wall. We pathologically confirmed that the mass was a metastatic renal cell carcinoma of clear cell type by incision biopsy. Through an incision biopsy, the mass was pathologically confirmed as a metastatic renal cell carcinoma of the clear cell type.