Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Medical Issues and Opinions of Obstetrics Regarding Abortion Law Amendment

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

NGF and HB-EGF: Potential Biomarkers that Reflect the Effects of Fesoterodine in Patients with Overactive Bladder Syndrome

PURPOSE: To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. MATERIALS AND METHODS: This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. RESULTS: Urinary levels of NGF/Cr (OAB: 1.13+/-0.9 pg/mg; control: 0.5+/-0.29 pg/mg) and HB-EGF/Cr (OAB: 8.73+/-6.55 pg/mg; control: 4.45+/-2.93 pg/mg) were significantly higher in subjects with OAB than in controls (p<0.001). After 16 weeks of fixed-dose fesoterodine treatment, urinary NGF/Cr levels (baseline: 1.13+/-0.08 pg/mg; 16 weeks: 0.60+/-0.4 pg/mg; p=0.02) and HB-EGF/Cr levels significantly decreased (baseline: 8.73+/-6.55 pg/mg; 16 weeks: 4.72+/-2.69 pg/mg; p=0.03, respectively). Both the OABSS and OAB q scores improved (p<0.001). However, there were no a statistically significant correlations between these urinary markers and symptomatic scores. CONCLUSION: Urinary levels of NGF and HB-EGF may be potential biomarkers for evaluating outcome of OAB treatment. Fixed-dose fesoterodine improved OAB symptoms. Future studies are needed to further examine the significance of urinary NGF and HB-EGF levels as therapeutic markers for OAB.

Changes in Sexual Function and Comparison of Questionnaires Following Surgery for Pelvic Organ Prolapse

PURPOSE: The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. MATERIALS AND METHODS: From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. RESULTS: Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99+/-0.18 vs. 7.56+/-1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width. CONCLUSION: In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function.

Comparison of midurethral sling outcomes with and without concomitant prolapse repair

OBJECTIVE: We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair. METHODS: We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis. RESULTS: We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970). CONCLUSION: The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study

OBJECTIVE: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). METHODS: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. RESULTS: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. CONCLUSION: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

Outcome of mid urethral sling procedures according to age / 대한산부인과학회지

OBJECTIVE: To compare the morbidity and treatment outcomes of mid urethral sling procedures for older women and younger women, and to evaluate whether mid urethral sling procedures can be effectively used in older women. METHODS: This retrospective study included 381 patients who underwent mid urethral sling procedures, tension free vaginal tape (TVT) or transobturator tape (TOT) for urodynamic stress urinary incontinence from March 2000 to June 2006. The patients were divided into two age groups: younger women (30~69 years old) and older women (70~90 years old). Patients were followed up with clinic visits at 1, 3, 6, 12 months, and every year thereafter. RESULTS: 341 (89.7%) were in younger women, 40 (10.5%) in older women. The rates of intra and perioperative complications including hemoglobin difference, urinary retention, UTI, mesh erosion, wound infection were no significant differences between the groups. De novo urgency was more common in older women than younger women (15.9% vs. 30.0%: P0.05) showed no significant differences. CONCLUSION: Our data showed subjective cure rates without any significant increase in intraoperative complications in older women. Postoperative complications of de novo urgency were more common in the older women. Hospital stay and recovery period were short, making TVT and TOT a suitable procedure for all ages.

Polymorphism of a COLIA1 Gene Sp1 Binding Site in Korean Women with Pelvic Organ Prolapse

PURPOSE: To evaluate the possible influence of G-->T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP). MATERIALS AND METHODS: The study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer. RESULTS: Two groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57degrees C on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p < .05. CONCLUSION: The polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea.

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

PURPOSE: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse > or = stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

Comparison between tension-free vaginal tape (TVT) and transobturator tape (TOT) with concomitant surgery for pelvic organ prolapse / 대한산부인과학회지

OBJECTIVE: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). METHODS: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student's t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. RESULTS: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91+/-0.93 g/dL; TOT, 1.53+/-0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. CONCLUSION: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications.

The comparison of treatment outcome of Transobturator tape and Tension-free vaginal tape obturator as the treatment of stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the treatment outcome of Transobturator tape (TOT) and Tension-free vaginal tape obturator (TVT-O) as the treatment of stress urinary incontinence (SUI). METHODS: This prospective study included 332 women who were urodynamically diagnosed as stress urinary incontinence from April 2005 to January 2007. Patients showing pelvic organ prolapse higher than stage II by the Pelvic Organ Prolapse Quantification system or patients with detrusor overactivity were excluded from this study. The patients were alternatively selected to undergo TOT (n=192) or TVT-O (n=140) procedure and followed up at 1, 3, 6, 12 months postoperatively to compare the treatment outcome. Three hundred and six of them were available at 1 year follow up, 185 had the TOT operation, 121 the TVT-O procedure. The student t-test, chi square test were used for statistical analysis. RESULTS: There were no statistically significant differences in general characteristics between two groups. No differences were found between 2 groups in the cure rates, postoperative complication such as voiding difficulty, De novo urgency, urinary tract infection, vaginal mesh erosion except groin pain. The groin pain rate of two groups showed significant difference. (TOT; 3.78% vs TVT-O; 9.92%, P=0.030). CONCLUSIONS: This study indicates that the TOT and TVT-O procedures are safe and effective treatments for female stress urinary incontinence. However, TVT-O shows high incidence of groin pain rate and it may be related to nerve irritation by inflammation of surrounding tissue around the pudendal and obturator nerve, according to anatomical differences of the tape position in two procedures.

Current opinion of the treatment of female voiding dysfunction / 대한산부인과학회지

The incidence of female voiding dysfunction is increasing nowadays and is getting more of attention with the aging society. Various treatment methods have been applied to treat stress urinary incontinence, overactive bladder, and voiding difficulty. However, surgery for stress urinary incontinence, medication and bladder training for overactive bladder, and intermittent self-catheterization to treat voiding difficulty remain as the mainstay of management. These standard methods cannot be applied to all patients, and does not always lead to successful outcomes, suggesting that we should acquire the correct knowledge in possible ways to treat these patients. In this review, we will focus on the treatment effects of conservative, medical, and surgical treatment which are currently available, based on the evidence of literatures, and address the promising therapeutic modalities such as new minimally invasive surgical procedures for stress urinary incontinence, botulinum toxin A injection, electrical stimulation (sacral neuromodulation, posterior tibial nerve stimulation), radiofrequency therapy, new pharmacologic agents for overactive bladder and voiding difficulty.

Current opinion of the treatment of female voiding dysfunction / 대한산부인과학회지

The incidence of female voiding dysfunction is increasing nowadays and is getting more of attention with the aging society. Various treatment methods have been applied to treat stress urinary incontinence, overactive bladder, and voiding difficulty. However, surgery for stress urinary incontinence, medication and bladder training for overactive bladder, and intermittent self-catheterization to treat voiding difficulty remain as the mainstay of management. These standard methods cannot be applied to all patients, and does not always lead to successful outcomes, suggesting that we should acquire the correct knowledge in possible ways to treat these patients. In this review, we will focus on the treatment effects of conservative, medical, and surgical treatment which are currently available, based on the evidence of literatures, and address the promising therapeutic modalities such as new minimally invasive surgical procedures for stress urinary incontinence, botulinum toxin A injection, electrical stimulation (sacral neuromodulation, posterior tibial nerve stimulation), radiofrequency therapy, new pharmacologic agents for overactive bladder and voiding difficulty.

Comparison of anterior repair, anterior repair with prolene mesh and internal anterior repair for surgical treatment of the central type of anterior vaginal wall defects / 대한산부인과학회지

OBJECTIVE: As for the method of surgical correlation of the central type of anterior vaginal wall defects, there are anterior repair, anterior repair with prolene mesh, and internal anterior repair. The object of this study was to compare the recurrence rates, complications and the clinical efficacy of the three surgical procedures. METHODS: We identified one hundred and thirty-eight patients who underwent operations for the central type of anterior vaginal wall defects from March 1999 to May 2005. We retrospectively collected data from the medical records and reviewed the outcomes. We investigated the characteristics of patients, recurrence rates and complication rates for the results, and compared them by ANOVA test and Kruskal-Wallis test. RESULTS: The number of cases of anterior repair, anterior repair with the mesh, and internal anterior repair were seventy-two, twenty-eight and thirty-eight consecutively. There was no significant difference in the characteristics of age, menopause status, parity, BMI (Body mass index) and history of pelvic surgery and the medico-surgical illness among the three groups. There were statistically no significant differences in fever, vaginal erosion, detrusor overactivity and voiding difficulty after the operations. The incidence of the postoperative urinary tract infections was increased significantly in the group of the anterior repair with prolene mesh (p=0.018), and drop in hemoglobin, operation time and wound infection were increased significantly in the group of the internal anterior repair (p=0.0001, 0.004 and p=0.028). The recurrence rate of the disease was significantly higher in internal anterior repair group than in anterior repair or anterior repair with the mesh groups (18.4% vs. 1.4% and 0%). The recurrence rate was increased in proportion to the duration after the surgery. CONCLUSION: The recurrence rate of the disease after internal anterior repair was significantly higher than when anterior repair or anterior repair with the mesh was done. As for the complications, urinary tract infection was increased after the anterior repair with prolene mesh and drop in hemoglobin and wound infection were increased after the internal anterior repair. We concluded that the conventional anterior repair is more suitable method for the correction of the central type of anterior vaginal wall defects than anterior repair with mesh and internal anterior repair.

Treatment outcome of tension-free vaginal tape in stress urinary incontinence: Comparison of intrinsic sphincter deficiency and non-intrinsic sphincter deficiency patients / 대한산부인과학회지

OBJECTIVE: The object of this study is to compare treatment outcomes of tension free vaginal tape (TVT) for intrinsic sphincter deficiency (ISD) and non-intrinsic sphincter deficiency (NISD) patients in stress urinary incontinence (SUI), and to evaluate whether TVT can be effectively used in both groups of SUI patients. METHODS: 111 women with SUI treated by TVT at the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, the Yonsei Medical Center from Jun. 2003 to Jun. 2005 were included in this study. The patients were divided into two groups; 31 patients with ISD, and 80 patients with NISD. SUI was diagnosed according to the result of urodynamic tests. Urodynamic studies (UDS) include uroflowmetry, multi-channel cystometry and urethral pressure profilometry. The Patients were followed up at 1, 3, 6, and 12 months postoperatively, and those with any follow-up loss were excluded from this study. RESULTS: There were no significant differences found in demographics between ISD and NISD groups; mean age, parity, BMI, menopausal status and HRT (P>0.05). Maximum urethral closure pressure (MUCP)(46.8124.29 vs.75.7+/-32.61 cmH2O; P<.0001) and Vasalva leak-point pressure (VLPP)(53.48+/-10.12 vs 107.23+/-42.95 cmH2O; P<0.0001) showed significant difference between the two groups. However, other parameters of UDS except MUCP and VLPP showed no statistical difference. The cure rates of the two groups at 1 month follow up (87.0% vs 100%; p=0.0053) showed significant difference. No significant differences were found at 3, 6 and 12 months. There were no differences in postoperative complication rate (voiding difficulty, de novo urgency, urinary tract infection) between two groups irrespective of follow-up months. CONCLUSION: Tension-free vaginal tape is effective for stress urinary incontinence in both ISD and NISD patients.

The effect of age on surgical morbidity in patients with pelvic organ prolapse / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to estimate the effect of age on the risk of in-hospital surgical morbidity in patients with pelvic organ prolapse (POP). METHODS: Of the women aged 40 years and older who underwent surgical correction of POP at this institution from March 1999 to February 2006, 322 had medical records that could be analyzed. These patients were grouped according to decade of age and assessed according to a set of characteristics and postsurgical complications. RESULTS: There were 35 patients between 40 to 49 years of age, 97 between 50 to 59 years, 123 between 60 and 69 years, 64 between 70 to 79 years and 3 patients were 80 years or older. There were no differences between age groups regarding the following variables: stage, delivery history, BMI, previous surgical history, underlying medical disease, duration of hospital stay, operation time, type of operation and anesthesia, difference of preoperative and postoperative hemoglobin level. There were differences only for parity. Also, between each age group, no statistical differences were noted in postoperative complications. CONCLUSION: The risk of in-hospital surgical morbidity in patients with POP was not related to the age of the patients.

Leiomyoma of the female urethra and bladder: 5 cases and review of the literature / 대한산부인과학회지

OBJECTIVE: Leiomyomas of the bladder and urethra in women is very rare. We present five cases of histologically proven the female urethral and bladder leiomyomas identified over a 15-years period at our institution, together with review of the literature focused on the symptom and proper management. METHODS: Five women pathologically confirmed bladder or urethral leiomyoma were reviewed by the medical record, retrospectively. RESULTS: One patient with bladder leiomyoma was asymptomatic, but four patients with urethral leiomyoma had a palpable mass on physical examination. The leiomyomas posited laterally were less symptomatic than other leiomyomas posited medially, and the symptoms were especially obstructive ones. All of them were removed by excision, and any complication or recurrence was not occurred. CONCLUSION: Leiomyomas of the bladder and urethra are rare and associated with variable symptoms depending on their locations and sizes. It is not necessary immediate operation except to excessive bleeding or acute complete obstruction. Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract.

Expression of Cdc25A, Cdc25B and Cdc25C in cervical carcinoma / 대한산부인과학회지

OBJECTIVE: This study was undertaken to quantitatively detect Cdc25A, Cdc25B and Cdc25C in cervical carcinoma and determine the relationship between the expression of mRNA and protein of cell division cycle (Cdc)25 phosphatase and various clinicopathologic prognostic factors of cervical carcinoma. METHODS: 39 patients diagnosed with cervical carcinoma between February 2000 to March 2005 and 10 patients with benign gynecologic disease were enrolled in this study. A reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blot analysis were used to analyze the expression of Cdc25 phosphatase mRNA and protein in fresh invasive cervical cancer tissue and normal cervix tissue. RESULTS: The mRNA expressions of Cdc25A, Cdc25B and Cdc25C in the cancer tissues were significantly greater than in the control (p=0.02, 0.01, 0.02), respectively. A Western blot analysis yielded same results (p=0.01, 0.02, 0.01). There were also significant relationships between the age and the Cdc25B mRNA expression (p=0.03), between the cell type and the Cdc25C mRNA expression (p=0.04). However, other clinicopathologic prognostic factors including stage, subtype, SCC Ag level, DNA flow cytometry, lymph node metastasis, lymphovascular space invasion and HPV positivity were not statistically significant. CONCLUSION: Our results show that Cdc25A, Cdc25B and Cdc25C expression levels were significantly greater in cervical cancer patient group than in those of control group. Thus Cdc25 phosphatase might play an important role in carcinogenesis of cervical carcinoma. Further studies based on the correlation between Cdc25 phosphatase and survival rate would be need to support Cdc25 phosphatase as a prognostic factor of cervical carcinoma.

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.

Clinical Experiences of Fetal Ovarian Cyst: Diagnosis and Consequence

Ovarian cysts are the most frequent, prenatally diagnosed intra-abdominal cysts. Fetal ovarian cyst often presents complication such as torsion and seems to be an indication for surgical intervention. In this study, we reviewed pre- and post-natal medical records and ultrasonography of 17 fetuses that were diagnosed with ovarian cysts. In a total of 17 cases, postnatal surgery was performed in 7 infants. Of these cases, four cases of ovarian cyst torsion were confirmed. In the remaining 10 fetuses, one case regressed completely during pregnancy, and the other nine cases including two complex cysts resolve spontaneously after birth. Postnatal symptomatic cysts or cysts with a diameter greater than 5 cm that do not regress or enlarge should be treated, but uncomplicated asymptomatic cysts less than 5 cm in diameter should only be observed and reassessed by serial ultrasonography. If they regress spon-taneously, no surgical intervention is necessary independent of their sonographic findings.