Implication of ADAM-8, -9, -10, -12, -15, -17, and ADAMTS-1 in Implantational Remodeling of a Mouse Uterus

In the present study, whether the ADAM-8, -9, -10, -12, -15, -17, and ADAMTS-1 proteins might play a role in mouse uterus during periimplantation period was investigated. Immunoblotting analyses demonstrated that all ADAM proteins consistently appeared throughout days 1 to 8 of pregnancy but with a variation depending on the species of ADAM gene, the progression of pregnancy, and the site of the uterus. Immunohistochemical analyses indicated that ADAM proteins were localized in the luminal or glandular epithelial layers with a varying intensity depending on the species of ADAM and the progression of pregnancy. Particularly ADAM-8, -12, and -15, were predominantly located in the implantation site of the uterine tissues, whereas little or no protein was localized in the interimplantation site. Based upon these observations, it is suggested that the ADAMs might play an important role in the remodeling of the mouse uterus during the periimplantation period.

Usefulness of Maternal Serum Amyloid A as a Predictor of Tocolytic Failure in Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: This study is directed to determine whether the concentrations of serum amyloid A (SAA) in maternal serum could be used to predict a tocolytic failure in preterm delivery, by comparing with other factors associated with inflammation. METHODS: A total of 100 pregnant women from September, 2000 to August, 2001 received continuous prenatal care and underwent delivery in our hospital was enrolled in the study. Gestational age was ranged between 20 and 37 weeks. Subjects were divided into four groups (group I, no preterm labor and no premature rupture of membranes [n=38]; group II, premature rupture of membranes and no preterm labor [n=12]; group III, preterm labor and no premature rupture of membranes [n=34]; Group IV, preterm labor and premature rupture of membranes [n=16]). The levels of SAA, CRP, ESR, and WBC count were measured in maternal serum. RESULTS: SAA levles, CRP levels, and WBC count in patients with tocolytic failure were significantly higher than those in patients without tocolytic failure. SAA and CRP appeared to be significant factors by logistic regression analysis. From the ROC curve analysis of maternal SAA for the prediction of tocolytic failure, we set 6 mg/L as a cut-off value in this study. Sensitivity, specificity, positive predictive value, and negative predictive value were 76%, 72%, 47.5%, and 90%, respectively. As for CRP, 0.59 mg/dL was set as a cut-off value, and sensitivity, specificity, positive predictive value, and negative predictive value were 72%, 81.3%, 56.3%, and 89.7%, respectively. When cut-off values for both SAA and CRP were applied at the same time, sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 92%, 71.4%, and 87.3%, respectively. CONCLUSION: This study showed that the measurement of maternal serum amyloid A may be a fast, non-invasive diagnostic method in the prediction of tocolytic failure in preterm delivery.

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.

Expression pattern of Aromatase Cytochrome P450 in Adenomyosis / 대한산부인과학회잡지

OBJECTIVE: To determine whether local estrogen production takes place in adenomyosis and in normal endometrium. METHODS: The study included 23 cases of adenomyosis and 17 cases of normal uterine endometrium obtained through hysterectomy or curettage at Kangnam Cha Hospital. The frozen tissue specimens were examined by immunohistochemistry using P450 arom. RESULTS: P450 arom was immunolocalized exclusively in the cytoplasm of glandular cells of adenomyotic tissue. However, no apparent staining was observed in stromal cells. Aromatase was expressed in the ectopic glands (82.6%), but also in the eutopic endometrium of patients with adenomyosis (23.5%). In the case of normal endometrium, P450arom was not detected. CONCLUSION: These results suggest that the aromatase activity is correlated to the pathophysiology of adenomyosis.

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.

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.

Isolation of Fetal Cells in Maternal Peripheral Blood and Genetic Analysis of Trisomy 21 by GPA-immuno FISH(Fluorescence in situ hybridization / 대한산부인과학회잡지

INTRODUCTION: Down's syndrome is the most common congenital chromosomal anomalies which occurs 1 out of 700-1000 births. Until now, for prenatal diagnosis of Trisomy 21, invasive techniques such as amniocentesis, chorionic villus sampling(CVS) and cordocentesis were used, but they encompass the rare possibility of morbidity to the mother and fetus. Triple marker using maternal serum is a currently used noninvasive method, but it only shows the accuracy of 60%. Accordingly, a noninvasive method, using fetal cells from maternal blood is under extensive investigation. This study was undertaken to establish a noninvasive prenatal genetic diagnostic method of trisomy 21 using fetal nRBCs rarely present in maternal circulation. MATERIALS AND METHODS: Peripheral venous blood samples were collected from 76 women and treated by heparin. For the isolation of fetal cells, we used a triple density gradient centrifugation, and Vario-MACS and Mini-MACS using CD45 and CD71, and then, the morphological differentiation of the fetal nRBC was performed by Kleihaur-Betke stain. With GPA immunostain, nRBCs were identified by cytoplasm and GPA attatchment, and after marking the site, a FISH was performed. RESULTS: This study population included 76 patients from 8 to 41 weeks of gestation, and nRBC was separated from all cases. The morphological differentiation was achieved by K-B stain. The mean number of nRBC collected from 20 ml of maternal peripheral blood was 15. The number of nRBCs retrieved reached its peak in 12-18 gestational weeks(18.9 6.0) which decreased from 20 gestational weeks and thereafter. Fetal sex was determined by FISH analysis using probe X, Y with GPA-immunostained cells. GPA-immuno FISH analysis using probe 21 in 30 cases of advanced maternal age or positive triple markers, we confirmed 3 cases of Down's syndrome. These results were also confirmed using the CVS or amniocentesis. CONCLUSIONS: Fetal nRBCs were separated from all cases after 8 gestational weeks. Prenatal diagnosis of trisomy 21 through GPA-immuno FISH analysis of chromosome 21 using separated fetal nRBCs is an useful, innovative, accurate, rapid and non-invasive diagnostic method. But for clinical use, more cases of experiments will be needed.

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.

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 Hypoxia on Telomerase Activity in Placental Tissue in Pregnancies with Fetal Growth Restriction / 대한산부인과학회잡지

OBJECTIVE: To observe the difference in telomerase activity (TA) expression in the placenta between fetal growth restriction (FGR) with preeclampsia and those without and to evaluate the effect of oxygen concentration on the TA expression in the trophoblastic cells. METHODS: Telomerase activity was measured in 48 (normal pregnancies, 16; preeclampsia with FGR, 15; normotensive FGR, 17) placentas which were obtained between 32 and 41 weeks' gestations. Trophoblastic cells were extracted from 8 chorionic villi samples obtained from 8-10 weeks' placenta and were cultured in either 2%, 8%, and 20% oxygen atmosphere. Then TA was examined by using telomeric repeat amplification protocol (TRAP) assay. RESULTS: During 3rd trimester of pregnancy, exhibited TA expression in normal pregnancy, FGR complicated by preeclampsia, and normotensive FGR groups were 11 of 16 (68.8%), 4 of 15 (26.7%), and 4 of 17 (23.5%), respectively. Significantly lower level of TA was detected in the FGR group compared to the normal pregnancies (p=0.009), whereas within FGR pregnancies, presence of preeclampsia did not seem to have statistically significant effect on TA expression. TA expression levels were measured by optical density in trophoblasts cultured under various oxygen concentration which revealed that significantly higher TA was exhibited in the cells cultured in 2% oxygen compared to 8% and 20% (p<0.001). However no significant difference was noted in TA between cells cultured in 8% and 20% oxygen. CONCLUSION: Decreased TA in the placenta from pregnancies with FGR was noted regardless of presence of preeclampsia indicating a probable correlation between FGR and placental senescence. Since increased TA was noted in trophoblastic cells that were cultured in hypoxic condition, we could speculate that the intervillous oxygen tension during early-stage placental development plays a certain role in the placental degeneration in pregnancies complicated by FGR and preeclampsia.

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.

The Role of Clinical and Biololgical Parameters to Predict Malignant Gestational Trophoblastic Tumor in Patients with Hydatidiform Mole / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to reevaluate the prognostic factors by investigating the clinical and biological parameters concerned malignant gestational trophoblastic tumor in patients with hydatidiform mole. METHODS: From March 1995 to February 2000, 41 patients admitted to department of the Obstetrics and Gynecology, Yonsei University College of Medicine who were diagnosed with pathologically-proven gestational trophoblastic disease were selected. Parameters such as age, gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction were compared between malignant gestational trophoblastic tumor group and spontaneous remission group. RESULTS: Considering the clinical prognostic factors, the patients were divided into two age groups; the first group consisted of those older than 40 years of age and the second control group consisted of those under 40. The number of patients older than 40 in the spontaneous remission group and malignant gestational trophoblastic tumor group were 4(15.4%) and 7(46.7%), respectively, showing a significantly higher number in the group over 40years. Other parameters such as gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction showed no statistically significant difference between the two groups. CONCLUSION: The progression rate from hydatidiform mole to malignant gestational trophoblastic tumor was significantly higher in patients over 40 years of age. Therefore, more aggressive therapeutic approach should be considered in such patients.