Spontaneous Rupture of Ovarian Artery Aneurysm in a Postmenopausal Woman: A Case Report and Literature Review

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.

Spontaneous Rupture of Ovarian Artery Aneurysm in a Postmenopausal Woman: A Case Report and Literature Review

Spontaneous rupture of an ovarian artery aneurysm is an extremely rare, life-threatening disease and has been reported to be most highly associated with pregnancy. The current study presents a case of intraperitoneal and retroperitoneal hematoma caused by spontaneous rupture of a right ovarian artery aneurysm in a 56-year-old woman. A 56-year-old woman visited the emergency room with right lower quadrant abdominal pain. Contrast-enhanced computed tomography showed a large retroperitoneal and intraperitoneal hematoma and active extravasation of contrast medium in the right retroperitoneum. Consequently, transcatheter arterial embolization was successfully performed. Spontaneous rupture of an ovarian artery aneurysm should be suspected in multiparous women with abdominal or flank pain even if it is unrelated to pregnancy. Suspicion of this entity is needed for earlier diagnosis and management.

Prediction Model for Massive Transfusion in Placenta Previa during Cesarean Section

0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.CONCLUSION: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.

Age-dependent changes of p53 and p63 immunoreactivities in the mouse hippocampus / 한국실험동물학회지

P53 and its family member p63 play important roles in cellular senescence and organismal aging. In this study, p53 and p63 immunoreactivity were examined in the hippocampus of young, adult and aged mice by using immunohistochemistry. In addition, neuronal distribution and degeneration was examined by NeuN immunohistochemistry and fluoro-Jade B fluorescence staining. Strong p53 immunoreactivity was mainly expressed in pyramidal and granule cells of the hippocampus in young mice. p53 immunoreactivity in the pyramidal and granule cells was significantly reduced in the adult mice. In the aged mice, p53 immunoreactivity in the pyramidal and granule cells was more significantly decreased. p63 immunoreactivity was strong in the pyramidal and granule cells in the young mice. p63 immunoreactivity in these cells was apparently and gradually decreased with age, showing that p63 immunoreactivity in the aged granule cells was hardly shown. However, numbers of pyramidal neurons and granule cells were not significantly decreased in the aged mice with normal aging. Taken together, this study indicates that there are no degenerative neurons in the hippocampus during normal aging, showing that p53 and p63 immunoreactivity in hippocampal neurons was progressively reduced during normal aging, which might be closely related to the normal aging processes.

RbAp48 expression and neuronal damage in the gerbil hippocampus following 5 min of transient ischemia / 한국실험동물학회지

Histone-binding protein RbAp48 has been known to be involved in histone acetylation, and epigenetic alterations of histone modifications are closely associated with the pathogenesis of ischemic reperfusion injury. In the current study, we investigated chronological change of RbAp48 expression in the hippocampus following 5 min of transient ischemia in gerbils. RbAp48 expression was examined 1, 2, 5, and 10 days after transient ischemia using immunohistochemistry. In sham operated gerbils, RbAp48 immunoreactivity was strong in pyramidal and non-pyramidal cells in the hippocampus. After transient ischemia, RbAp48 immunoreactivity was changed in the cornu ammonis 1 subfield (CA1), not in CA2/3. RbAp48 immunoreactivity in CA1 pyramidal neurons was gradually decreased and not detected at 5 and 10 days after ischemia. RbAp48 immunoreactivity in non-pyramidal cells was maintained until 2 days post-ischemia and significantly increased from 5 days post-ischemia. Double immunohistofluorescence staining revealed that RbAp48 immunoreactive non-pyramidal cells were astrocytes. At 5 days post-ischemia, death of pyramidal neurons occurred only in the CA1. These results showed that RbAp48 immunoreactivity was distinctively altered in pyramidal neurons and astrocytes in the hippocampal CA1 following 5 mins of transient ischemia. Ischemia-induced change in RbAp48 expression may be closely associated with neuronal death and astrocyte activation following 5 min of transient ischemia.

The Review of Victims of Violence from the Perspective of Physical Injury / 신경정신의학

Violence against socially vulnerable victims such as that associated with child abuse, domestic violence, and sexual assault has become a considerable problem in Korean society. Government resources have been invested in establishing effective response systems that can minimize the damage by identifying the causes of violence-related incidents, preventing them, and correcting the underlying problems. The starting point for such solutions is to recognize an incidence involving violence. Because victims do not tend to reveal incidents voluntarily, the ability of health care providers to recognize victims of violence is important. In the case of domestic violence, a victim who comes to the hospital while hiding the actual situation may have suffered more serious physical injuries than reported. A screening tool for child abuse has been developed to distinguish survivors of abuse among children who have come to the emergency room due to trauma. In addition, sexual abuse forensic emergency medical kits have been developed since 2002 and have been put into practice. One-stop service centers and ‘Sunflower’ Centers can support violence-related health care more systematically than that provided by other means.

Corrigendum: Association between Serum Fibroblast Growth Factor 21 Levels and Bone Mineral Density in Postmenopausal Women

No abstract available.

Association between Serum Fibroblast Growth Factor 21 Levels and Bone Mineral Density in Postmenopausal Women

BACKGROUND: Despite the beneficial effect of fibroblast growth factor 21 (FGF21) on metabolic disease, there are concerns about adverse effects on bone metabolism, supported by animal studies. However, a recent human study showed the positive association between serum FGF21 level and bone mineral density (BMD) in healthy premenopausal women. We undertook this study to examine the association between FGF21 level and BMD in healthy postmenopausal Korean women who are susceptible to osteoporosis. METHODS: We used data of 115 participants from a cohort of healthy postmenopausal women (>50 years old) to examine the association between serum FGF21 level and BMD. The clinical characteristics were obtained from the participants, and blood testing and serum FGF21 testing were undertaken. BMD of the lumbar spine, femoral neck and total hip area, and bone markers were used in the analyses. RESULTS: The mean age of the participants was 60.2±7.2 years. Serum FGF21 levels showed negative correlation with BMD and T-scores in all three areas, but there were no statistically significant differences. Multivariate analyses with adjustment for age and body mass index also did not show significant association between serum FGF21 level and BMD. In addition, serum FGF21 level also showed no correlation with osteocalcin and C-telopeptide levels. CONCLUSION: In our study, serum FGF21 level showed no significant correlation with BMD and T-scores.

High Serum Osteopontin Levels Are Associated with Low Bone Mineral Density in Postmenopausal Women

Osteopontin (OPN) is an acidic, noncollagenous matrix protein produced by the bone and kidneys. It is reportedly involved in bone resorption and formation. We examined the association between serum OPN levels and bone mineral density in postmenopausal women. Premenopausal women (n=32) and postmenopausal women (n=409) participated in the study. We measured serum osteopontin levels and their relationships with bone mineral density and previous total fragility fractures. The postmenopausal women had higher mean serum OPN levels compared to the premenopausal women (43.6+/-25.9 vs 26.3+/-18.6 ng/mL; P<0.001). In the postmenopausal women, high serum OPN levels were negatively correlated with mean lumbar bone mineral density (BMD) (r=-0.113, P=0.023). In a stepwise multiple linear regression model, serum OPN levels were associated with BMD of the spine, femoral neck, and total hip after adjustment for age, body mass index, smoking, and physical activity in postmenopausal women. However, serum OPN levels did not differ between postmenopausal women with and without fractures. Postmenopausal women exhibit higher serum OPN levels than premenopausal women and higher serum OPN levels were associated with low BMD in postmenopausal women.

A Case of Extreme Uterine Hypotrophy in Hypogonadotropic Hypogonadism with Partial GH Deficiency

Congenital hypogonadotropic hypogonadism is one of the causes of pubertal failure and primary amenorrhea, it is related to uterine hypotrophy. If the uterus is extremely hypotrophied, it is difficult to identify in imaging studies and can be misdiagnosed as a structural anomaly of internal genitalia. We report a case of extreme uterine hypotrophy in 18-year-old girl with primary amenorrhea that was finally diagnosed as hypogonadotrophic hypogonadism. The patient was initially suspected of Mullerian agenesis owing to the invisible uterus. After 4 months of treatment with estrogen, she showed significant growth of the uterus.

A Case of Extreme Uterine Hypotrophy in Hypogonadotropic Hypogonadism with Partial GH Deficiency

Congenital hypogonadotropic hypogonadism is one of the causes of pubertal failure and primary amenorrhea, it is related to uterine hypotrophy. If the uterus is extremely hypotrophied, it is difficult to identify in imaging studies and can be misdiagnosed as a structural anomaly of internal genitalia. We report a case of extreme uterine hypotrophy in 18-year-old girl with primary amenorrhea that was finally diagnosed as hypogonadotrophic hypogonadism. The patient was initially suspected of Mullerian agenesis owing to the invisible uterus. After 4 months of treatment with estrogen, she showed significant growth of the uterus.

Low Handgrip Strength is Associated with Low Bone Mineral Density and Fragility Fractures in Postmenopausal Healthy Korean Women

Osteoporosis is a widely recognized health problem in postmenopausal women. Osteoporotic fractures reduce independency, limit daily living activities, and increase the mortality rate. Epidemiological studies have demonstrated that low handgrip strength is a risk factor for functional limitations and disabilities, and all-cause mortality. We investigated the relationship between handgrip strength and bone mineral density (BMD) of the spine, femur neck, and total hip, as well the relationship between handgrip strength and previous fragility fractures in 337 healthy postmenopausal Korean women (mean age of 59.5 +/- 6.8 yr) who were free of diseases or medications affecting bone metabolism. Age and handgrip strength were associated with BMD of the spine, femur neck, and total hip in multiple regression models. Low handgrip strength (odds ratio [OR], 0.925; range, 0.877 to 0.975; P = 0.004) and low femur neck BMD (OR, 0.019; range, 0.001 to 0.354; P = 0.008) were independent predictors of previous fragility fractures in a multiple regression model. Our results demonstrate that low handgrip strength is associated with low BMD of the spine, femur neck, and total hip, and with increased risk of previous fragility fractures.

Comparison of follitropin beta administered by a pen device with follitropin beta administered by a conventional syringe in patients undergoing IVF-ET / 대한생식의학회지

OBJECTIVE: To compare the effectiveness and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin beta solution in patients undergoing IVF-ET. METHODS: GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). RESULTS: There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin beta. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. CONCLUSION: The pen device for self-administration of follitropin beta is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin beta when compared with the conventional syringe.

Comparison of follitropin beta administered by a pen device with follitropin beta administered by a conventional syringe in patients undergoing IVF-ET / 대한생식의학회지

OBJECTIVE: To compare the effectiveness and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin beta solution in patients undergoing IVF-ET. METHODS: GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). RESULTS: There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin beta. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. CONCLUSION: The pen device for self-administration of follitropin beta is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin beta when compared with the conventional syringe.

Prenatal diagnosis of large subamniotic cyst compressing the umbilical cord on umbilicoplacental junction : A case report / 대한산부인과학회지

Placenta surface cyst classified subamniotic hematoma, subchorionic hematoma and subchorionic cyst by histological finding. These cysts did not affect the obstetrical outcome according to the previous report. However, we experienced that the subamniotic cyst compressed the umbilical cord to result in fetal deceleration. We report this case with brief review of literature.

Generation accumulation of murine ovarian genes in offspring exposed to microwave in uterus / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate generational accumulation of murine fetal ovarian genes following prenatal exposure to 1.765-GHz microwave radiation. METHODS: A 1.765-GHz microwave generator was used. Twenty pregnant ICR mice were divided into two groups: the microwave-exposed experimental (irradiated) group, and the sham-exposed (sham) group. On the fifth day post-mating, dam mice were exposed to microwave irradiation in the insulated cage for 8 hours each day. The remaining mice were treated in the same way. Second generation mice were raised for 8 weeks then classified into four groups for examination. We removed the neonatal ovaries on the seventh day after the third delivery. We investigated the expression of six genes in the ovaries: Tnfaip 8, TNFsf 12, Cfd, CCL 11, Zfp 74, and Brd 3. Real time reverse transcription-polymerase chain reaction was performed using total RNA extracted from the removed ovaries. RESULTS: In the third-generation offspring, we detected some differences in ovarian gene expression between the first group and the fourth. Expression of CCL 11, and TNFsf 12 was decreased in the first group compared to the fourth group. Expression of Tnfaip 8, brd 3, Cfd, and Zfp 74 was higher in the first group than in the fourth group. We found differing results when we compared ovarian gene expression in mice of the second generation with those of the third. CONCLUSION: The results suggest that there is no generational accumulation of murine ovarian genes in offspring exposed to 1.765-GHz microwaves in the uterus.

Isolated torsion of the hydrosalpinx after hysterectomy: A case report / 대한산부인과학회지

Isolated tubal torsion is a rare disease that causes acute lower abdominal pain. In most of cases, the ovary and the fallopian tube are together twisted due to an ovarian tumor, but the fallopian tube alone is rarely twisted. Tubal torsion mainly occurs in fertile women, and it rarely occurs prior to menarche and during menopause. We experienced a case where isolated tubal torsion occurred in a perimenopausal female with total abdominal hysterectomy, while the findings showed a normal ovary. We report this case with a brief review of related literature.

Uterine necrosis after partial obstruction of the uterine artery via selective embolization in postpartum hemorrhage: A case report / 대한산부인과학회지

Selective uterine arterial embolization is widely used in the management of obstetric hemorrhage. Owing to the physiological changes associated with pregnancy and selection of uterine arteries, ischemic injury after uterine arterial embolization in postpartum bleeding is rare. In previous reports, the known causes of ischemic injury after embolization are using the too small particle and complete occlusion of fine branch of uterine artery with absence of collateral ovarian artery. We experienced uterine necrosis despite partial obstruction of uterine arteries following the selective embolization. We report this case with brief review of literature

Microarray analysis of gene expression in mice ovaries exposed to a 1.765 GHz microwave in utero / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the effects on murine fetal ovarian gene expression of prenatal exposure to 1.765 GHz of microwave irradiation. METHODS:Ten pregnant ICR mice were divided into two groups. At 5th days after mating, dam mice were exposed to microwave (SAR: 0.38~1.71 W/kg) in the insulated cage for 8 hours each day. The remaining mice were treated in the same way. Neonatal ovaries were removed for study 7 days after delivery. Microarray analysis was performed using total RNA extracted from the removed ovaries. We investigated the differences in ovarian gene expression between the groups. SPSS 12.0 was used for statistical analysis. P<0.05 was considered to be statistically significant. RESULTS: The mean birth weight of the offspring in the irradiated group was significantly lower than that in the sham group (1.54+/-.22 g vs. 1.60+/-.21 g, P=0.012). The mean number of offspring per pregnancy in the irradiated group was significantly higher than in the sham group (13.60+/-.70 vs. 11.40+/-.17, P=0.009). We detected that in the irradiated ovaries, 14 genes were expressed at levels 2-fold higher than in the sham ovaries and 74 genes were expressed at levels 2-fold lower than in the sham ovaries. CONCLUSION: We found differences in fetal ovarian gene expression between the irradiated and sham groups. In the irradiated group, the Tnfaip8, TNFsf 12, Cfd, CCL 11, and Zfp74 genes were down-regulated and the Brd 3 gene was up-regulated.

Microarray analysis of gene expression in mice ovaries exposed to a 1.765 GHz microwave in utero / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the effects on murine fetal ovarian gene expression of prenatal exposure to 1.765 GHz of microwave irradiation. METHODS:Ten pregnant ICR mice were divided into two groups. At 5th days after mating, dam mice were exposed to microwave (SAR: 0.38~1.71 W/kg) in the insulated cage for 8 hours each day. The remaining mice were treated in the same way. Neonatal ovaries were removed for study 7 days after delivery. Microarray analysis was performed using total RNA extracted from the removed ovaries. We investigated the differences in ovarian gene expression between the groups. SPSS 12.0 was used for statistical analysis. P<0.05 was considered to be statistically significant. RESULTS: The mean birth weight of the offspring in the irradiated group was significantly lower than that in the sham group (1.54+/-.22 g vs. 1.60+/-.21 g, P=0.012). The mean number of offspring per pregnancy in the irradiated group was significantly higher than in the sham group (13.60+/-.70 vs. 11.40+/-.17, P=0.009). We detected that in the irradiated ovaries, 14 genes were expressed at levels 2-fold higher than in the sham ovaries and 74 genes were expressed at levels 2-fold lower than in the sham ovaries. CONCLUSION: We found differences in fetal ovarian gene expression between the irradiated and sham groups. In the irradiated group, the Tnfaip8, TNFsf 12, Cfd, CCL 11, and Zfp74 genes were down-regulated and the Brd 3 gene was up-regulated.