Complementary Medicine in Gynecology / 한양의대학술지

The use of complementary and alternative medicine (CAM) for health maintenance and disease management has been on a steady rise for more than 10 years. The number of visits to alternative care providers seems to have exceeded the number of visits to primary care providers. Most of these users are women who are frequently making decisions regarding treatment options without the advice of their physicians. The spectrum of CAM is broad and includes methods worthy of integration into our current practics, as well as ineffective or fraudulent practices that should be avoided. The management of many women's health issues can be enhanced by the integration of selected CAM approaches. Important issues of CAM use in the gynecologic field are menstrual disorders such as premenstrual syndrome and dysmenorrhea, Infertility and menopause. The purpose of this article is to provide the clinician with current information of CAM of the above mentioned gynecologic issues and to be helpful in providing benefits to patients with appropriate treatment options.

Ovarian cancer related gene targeting with large circular antisense library / 대한산부인과학회지

OBJECTIVE: The aim of this study is to find out the genes which are related to ovarian cancer cell growth using large circular antisense library. METHODS: Clones for antisense library were uni-directionally sub-cloned into pBS SK (-) vector. LC-antisense molecules were then purified from the culture supernatants of the bacterial competent cells superinfected with M13K07 helper bacteriophages. The LC-antisense library to 240 unigene clone was constructed and utilized in the identification of genes functionally involved in the growth of ovarian cancer cells. RESULTS: The 17 numbers out of the 240 numbers of the antisense library exerted a marked inhibitory effect on the growth of SK-OV 3. CONCLUSION: The putative functional categorization of each gene was then conducted via public databases. These candidates may be used as target genes for drug development or adjuvant of conventional chemotherapeutic drugs.

Effect of prolactin on ovarian tissue-type palsminogen activator and prostaglandin E2 in superovulated rat / 대한산부인과학회지

OBJECTIVE: This study is to analyze the direct effects of hyperprolactinemia, cause of anovulation and infertility, on ovarian function. METHODS: The prepubertal female Sprague-Dawley (SD) rats were obtained and ovulation was induced with PMSG and hCG s.c.. The rats were divided into four groups, which received the following treatments IP : saline 0.2 ml, 150 ug PRL, 300 ug PRL, 300 ug PRL plus 300 ug naloxone. The animals were killed and the oviducts were evaluated for the presence of ova. The ovary were then removed and evaluated under light microscopy. For changes of follicular t-PA and PGE2 concentration after PRL, immature female SD rats were stimulated as described above. At four hours after the hCG injection the rats were killed and the ovaried were removed. Each isolated ovaries were incubated in culture plate containing incubation medium or 300 ng PRL to be tested. And PRL plus gonadotropin in incubation medium was tested because of change of PGE2 concentration. After incubation period, t-PA and PGE2 were measured by EIA. Differences between groups were assessed by two-way ANOVA of variance followed Mann-Whitney U test or Kruskal-Wallis test for multiple comparisons. p<0.05 was considered statistically significant. RESULTS: As result, prolactin transiently suppresses ovulation, especially with its increased concentration not by altering the ovarian morphology. But ovulation inhibition was reversed by naloxone injection. The level of t-PA in control and prolactin-treated group increased steadily in response to human chorionic gonadotropin administration, yet lower in prolactin-treated group. But PGE2 concentration was increased in gonadotropin mixed groups but not affected in prolactin-treated group despite a significant blockade of ovulation. CONCLUSION: Thus, further studies on the effect of high level prolactin on ovulatory function would significantly contribute toward the patient with hyperprolactinemia for managing infertility and maintaining appropriate female reproductive function.

A case of diastasis of the symphysis pubis accompanying gait disturbance developed before labor pain / 대한산부인과학회지

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.

Effects of alpha-Tocopherol on Cadmium-Induced Toxicity in Rat Testis and Spermatogenesis

Cadmium is known to exert toxic effects on multiple organs, including the testes. To determine if alpha-tocopherol, an antioxidant, could protect testicular tissues and spermatogenesis from the toxic effects of cadmium, six-week old male Sprague-Dawley rats were randomized to receive cadmium at doses of 0 (control), 1, 2, 4 or 8 mg/kg by the intraperitoneal route (Group A) or alpha-tocopherol for 5 days before being challenged with cadmium (Group B) in an identical dose-dependent manner. When both groups received cadmium at 1 mg/kg, there were no changes in testicular histology relative to controls. When Group A received cadmium at 2 mg/kg, undifferentiated spermatids and dead Sertoli cells increased in the seminiferous tubules while interstitial cells decreased and inflammatory cells increased in the interstitial tissues. On flow cytometric analysis, the numbers of elongated spermatids (M1) and round spermatids (M2) decreased while 2c stage cells (M3, diploid) increased. In contrast, when Group B received cadmium at 2 mg/kg, the histological insults were reduced and the distribution of the germ cell population remained comparable to controls. However, alpha-tocopherol had no protective effects with higher cadmium doses of 4 and 8 mg/kg. These findings indicate that alpha-tocopherol treatment can protect testicular tissue and preserve spermatogenesis from the detrimental effects of cadmium but its effectiveness is dependent on the dose of cadmium exposed.

Perforation of the small bowel by a previously inserted intrauterine contraceptive device / 대한산부인과학회지

Intrauterine contraceptive device (IUD) is the most common contraceptive method in the world, but it exists a little risk of uterine perforation and even more severe risk such as a perforation of intra-abdominal organs. In this case, the patient recognized that the previously inserted IUD was translocated but she was asymptomatic without any management. After insertion of the second IUD, she visited our hospital for lower abdominal pain. The abdominal X-ray finding and transvaginal sonography revealed one translocated IUD in peritoneal cavity and another IUD in intrauterine cavity. Thus, we report a case with the laparoscopic diagnosis of small bowel perforation by a previously inserted IUD and its removal by segmental resection of small bowel after mini-laparotomy, along with the brief review.

Risk of Cesarean Section Delivery after Induction of Labor at Postterm Pregnancy in Nulliparous Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. METHODS: The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks' gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. RESULTS: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59+/-2.57 in cesarean delivery group and 26.99+/-2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70+/-2.82 and 25.75+/-2.67 kg/m2. GA was 41.36+/-0.27 weeks in cesarean delivery group, whereas 41.20+/-0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31+/-358.22 g and 34.59+/-1.18 cm in cesarean delivery group, compared to 3363.95+/-361.22 g and 34.03+/-1.34 cm in vaginal delivery group. CONCLUSION: The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.

3 Cases of Primary Tubal Cancer Incidentally Diagnosed After Benign Gynecologic Operation / 대한산부인과학회지

We experienced 3 cases of early stage tubal cancer incidentally recognized during the operation and diagnosed pathologically after surgery of the tubo-ovarian abscess, the symptomatic adenomyosis, the myoma with adnexal cyst patients, so we report our cases with a review of the literature.

The Study of Anti-HEV(Ig G) Positive Rate of Pregnant Women in Kyeong Ju / 대한산부인과학회잡지

Hepatitis E was formerly caused enterically-transmitted, waterborne, or fecal-oral non-A, non-B hepatitis. Hepatitis E has its highest care-fatality rates in pregnant women. The study was undertaken with the objection of searching the Anti-HEV(IgG) positive rate in Kyeong Ju, Korea. A total of 500 pregnant women who visited the antenatal clinic were selected during the period from November, 1993 to June, 1994 at the department of Obstetrics and Gynecology, Kyeong Ju hospital, Dongguk university and taken the test for IgG anti-HEV with ELISA kit. The positive rate of IgG anti-HEV was 2.8%. So we recommanded that anti-HEV is included in addition to HBsAg and ALT in prenatal screening tests for pregnant women, who have had clinical history of hepatitis.

Clinical Study of the Duration of CO2 Absorption of ROK and USA-produced Soda Lime and Their Re-use Time after Being Exhausted / 대한마취과학회지

BACKGROUND: In a circle system, gas that is to be reused is cleared of carbon dioxide by passing through a canister containing a chemical CO2 absorbent. In anesthesia textbooks the utilization time of carbon dioxide is nearly always specified to last about 5 hours. The soda lime used was noted to regenerate its efficiency for CO2 absorption after being exhausted. Two different types of soda lime (a ROK product and USA product) were analyzed in patients for their duration of carbon dioxide absorption from the anesthetic closed circle system and re-use time after being exhausted. METHODS: General inhalation anesthesia was performed using a PhysioFlex anesthesia machine. To determine the duration of carbon dioxide absorption by soda lime and the re-use time after being exhausted, twenty seven (ROK; 20 and USA; 7) and fifty (ROK; 22 and USA; 28) adult patients were studied. Duration of CO2 absorption was determined as the time for the inspired CO2 concentration to reach 0.5%. The color change of ethyl violet in soda lime was observed throughout the study. Duration of CO2 absorption was compared by unpaired t-test. Re-use time of each group was analysed by simple regression; p less than 0.05 was considered significant. RESULTS: Duration of CO2 absorption was 2.67 +/- 2.12 hrs for the ROK product and 9.52 +/- 0.68 hrs of USA product, and they were different significantly (P < 0.05). Regression equations of ROK- and USA-products werey (min) = 5.761x + 45.701 (r2 = 0.0438, P = 0.3496, x means day after being exhausted) and y = 0.6x + 33.179 (r2 = 0.0158, P = 0.5233) respectively. A color change of ethyl violet in ROK soda lime was not observed throughout the chemical reaction. CONCLUSIONS: From the above results we suggest that ROK soda lime is not effective yet to use for CO2 absorption in clinical anesthesia. It is marked shorter than that of the USA soda lime. A color change of ethyl violet was not observed throughout the chemical absorption reaction in ROK soda lime. Re-use time of both soda limes were not related with the duration after being exhausted.

Clinical Study for the Feasibility of Total Vaginal Hysterectomy on the Cases with Contraindication / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the feasibility of vaginal hysterectomy on contraindicated cases. MATERIAL AND METHODS: We examined the medical records of 154 patients who underwent vaginal hysterectomy and 139 patients who underwent abdominal hysterectomy from March 1999 to March 2002. Among vaginal hysterectomy group, 77 patients (Group I) were found to have more than one contraindication for vaginal hysterectomy such as large uterus (>280 g), nulliparous or no previous vaginal delivery, and previous pelvic laparotomy. Remaining 77 patients (Group II) had no contraindications for vaginal hysterectomy. These two groups were compared with 139 abdominal hysterectomy patients (Group III) regarding preoperative surgical indication, uterus size, operative time, bleeding volume, hospital stay, pain duration and postoperative complications. RESULTS: 1. The Group II patients were older than the other groups (Group I 45.9 years; Group II 53.4 years; Group III 45.9 years) and had history of higher parity by vaginal delivery (Group I 2.5; Group II 3.5; Group III 2.1). 2. The most common indication of hysterectomy was myoma in Group I (59.7%) and Group III (71.9%) and uterine prolapse in Group II (41.6%). 3. The average bleeding volume during the operation was greater in Group III (308.6 ml) than Group I (123.4 ml) and Group II (116.2 ml)(p<0.01). 4. The operative time was longer in Group III (105.4 min) than the other groups (P<0.01). 5. Hospital stay was shorter in Group I (7.6 days) and II (7.6 days) than Group III (8.8 days)(P<0.01). 6. The pain duration was shorter in Group I (1.53 days) and Group II (1.59 days) than in Group III (2.23 days)(P<0.01). 7. The incidence of postoperative major and minor complications was significantly higher in Group III (38.8%) than the other groups (Group I 24.6%; Group II 19.5%)(P<0.01). CONCLUSION: The vaginal hysterectomy is still safe and effective procedure for the patients who have contraindications such as a large uterus, nulliparity or no previous vaginal delivery and previous laparotomy except the cases with immobility of uterus by severe pelvic adhesion.

Musculoskeletal Problems in Pregnancy

OBJECTIVE: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy. METHOD: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed. RESULTS: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age. CONCLUSION: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.

The effect of fentanyl and midazolam on in vitro fertilization and early development of mouse embryo / 대한산부인과학회잡지

OBJECTIVE: To assess the effect of fentanyl and midazolam on in vitro fertilization rate and early embryo development in a mouse IVF model. METHODS: Mouse oocytes were exposed in vitro to fentanyl at a concentration of 0(control), 50, 250, 500, 1000, 5000 pg/ml, and midazolam, 0(control), 2.5, 12.5, 25, 50, 250 ng/ml for 30 minutes, washed and inseminated. Thereafter fertilization was assessed. And subsequent in vitro development to the blastocyst stage was monitored daily. RESULTS: Where fertilization occurred, subsequent embryo cleavage and development up to the blastocyst stage was affected significantly by the presence of fentanyl and midazolam solution in the medium(i.e., 14% to 31%, 10% to 35%), in comparison with control group( 60%, 62%). CONCLUSION: It can be concluded from these experiments that even a brief exposure of cumulus enclosed oocytes to a low concentration of fentanyl, midazolam is deleterious to subsequent cleavage.

Clinicopathological Analysis of Malignant Germ Cell Tumors of Ovary / 대한부인종양콜포스코피학회잡지

Malignant germ cell tumors occur in children and young women in reproductive age, of all the germ cell malignancies, only pure dysgerminomas had a high cure rate prior to 1970. This was due to the exquisite radiosensitivity of these tumors. Multiple-agent chemotherapy has dramatically improved the pmgnosis of patients with malignant ovarian germ cell tumors. Clinicopathological analysis was performed on 21 cases of malignant germ cell tumors of the ovary, 9 cases at the department of Obstetrics & Gynecology, Kyung-pook National University Hospital, 4 cases, at the department of Obstetrics and Gynecology, Dong-guk University Kyungju Hospital and 8 cases, at the department of Obstetrics and Gynecology, Dae-gu Fatima Hospital during the period 10 years from July. 19S8 to June. 1997 The results were summarized as follows: 1. The mean age of the patients was 21.8 years old, ranging from 10 to 61 years old. 2. Main initial symptoms were abdominal distension(33.3%), abdominal mass palpation(33.3%), abdominal pain(28.6%), amenorrhea(4.8%) in order. 3. Histologically, the tumors were classified as immature teratoma(57.1%), dysgerminoma(19%), mixed germ cell tumor(9.5%), endodermal sinus tumor(9.5%), embryonal cell carcinoma(4.8%). 4, According to FIGO classification Stage I was the most prevalent(57.1%) at the time of diagnosis while Stage III was forward in 48.6%, Stage II in 9.5%, and no Stage IV, 5. The 5-year survival rate was 80.4% and three patients have died of malignancy and the other 18 patients live without disease from 11 to 102 months, with a median follow-up of 34.2 months. 6. Prognostic factors of malignant germ cell tumors in this study were the clinical stage, the presence of ascites and the residual tumor mass.

Analysis of Body Mass Index in 4,966 Patients Undergoing Operations / 대한마취과학회지

BACKGROUND: Obesity is defined as an excess accumulation of body fat. To measure body fat accurately is difficult, but body mass index (BMI, kg/m2) is easily available for routine clinical use. METHODS: A total of 4,966 (male; 2,580, female; 2,386) patients from January to September in 1997 and aged up to 90 years old were studied for BMI. Among these subjects, obstetric patients were excluded in our study. We calculated the BMI as weight (kg) per height squared (m2). The heights and weights of study subjects were obtained from anesthesia records. The BMI was analyzed by 4 different age groups: group 1 (less than 3 years), group 2 (between 3 to 7 years), group 3 (between 8 to 17 years), and group 4 (18 years or more), decade of age, 4 obesity categories according to BMI levels: underweight (less than 18 kg/m2), normal weight (19-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (30 kg/m2 or more), and surgical departments. RESULTS: Mean BMI values of group 1, 2, 3, and 4 were 16.1+/-2.9 kg/m2, 16.2+/-2.4 kg/m2, 19.2+/-3.7 kg/m2 and 23.3+/-4.6 kg/m2 in males and 15.7+/-3.9 kg/m2, 15.8+/-2.7 kg/m2, 19.4+/-3.5 kg/m2 and 23.6+/-3.7 kg/m2 in females, respectively. According to generations, the BMI under teen-age was 16.3+/-2.7 kg/m2 and 14.3+/-2.9 kg/m2 in males and females respectively while it was between 20.4+/-3.3 kg/m2 to 25.0+/-3.6 kg/m2 from 1st to 7th decade patients in both sex. The prevalence of overweight and obesity were nearly zero in group 1 and 2, but males in group 3 had them of 4.6% and 1.4% while 6.9% and 0.8% in females, respectively. In group 4 they were 25.3% and 2.2% in males and 28.8% and 4.8% in females, respectively. Obese patients increased in the order of neurosurgery, gynecology, orthopedic surgery, urology, and general surgery departments. CONCLUSIONS: This study revealed the guidelines of BMI of operating patients. We recognized that the prevalence of overweight and obesity of preschool aged and adolescent patients were nearly zero. Adult patients were the highest at 4th decade in males and 6th decade in females and the obesity rates were 27.4% and 33.6% in males and females, respectively.

A Case of Adenomyotic Cyst Within Myometrium Accompanied with Endometriosis / 대한부인종양콜포스코피학회잡지

Adenomyotic cyst is very rare disease, their sizes are mostly lesser 5mm. The intrauterine adenomyotic cyst may arise from progressive expansion of cyst due to progressive menstrual bleeding. Authors experienced a case of large adenomyotic cyst within myometrium occuring in a l9-year-old woman, and who was accompanied with endometriosis. The cyst was about 3 x 3em sized, and had chocolate colored thick viscous contents, We experienced one case of adenomyotic cyst which was thought to be degenerated uterine myoma, so we report the case with a brief review of the concerned literatures.

A Clinical Study of Pregnancy and Delivery in Pregnant Women 35 Years and Older / 대한산부인과학회잡지

OBJECTIVE: We studied the effects of the age factor in pregnant women who are over the age of 35 on pregnancy, parturition and verified its usefulness in the future managements of the old aged pregnancy. METHODS: Out of 2,526 mothers who delivered in Dongguk university hospital from April 2000 to June 2003, we selected 183 mothers who aged more than 35 years as a study group, and 150 mothers aged between 25 and 29 years as a control group. We then statistically evaluated and analyzed the two groups. RESULTS: Study group consumed up to 7.24%. Placenta previa, male birth delivery, abnormal presentation, low birth weight, iron deficiency anemia and preterm labor was noted more in the study group. Likewise, preterm delivery, pregnancy induced hypertension and cesarean section rates were significantly high in the study group. CONCLUSION: Pregnancy in old age is currently a rising trend. Whlie they might have the tendency to show prenatal complications, neonatal complication and difficult decision making in delivery method, early detection and treatment of presumable complications by adequate antenatal care and appropriate selection of delivery method can reduce the section rates and obtain relatively successful pregnancy outcome.

A Case of Congenital Intracranial Immature Teratoma / 대한산부인과학회잡지

Congenital intracranial teratoma is a very rare tumor. We recently experienced a case of massive congenital intracranial teratoma that discovered in a male infant of 28 weeks of gestation. A 33-year old multigravida was observed at 28 weeks gestation for prenatal ultrasound examination and ultrasonography revealed the fetus was severely macrocephalic with marked hydrocephalus. For therapeutic termination, Hysterotomy and fetal cephalocentesis was performed to deliver a stillborn infant. Autopsy revealed a 2,420 g male infant with severe macrocephaly. A multilobulated intracerebral tumor was found a diameter 18 cm involving both cerebral hemisphere. The tumor was considered to have originated in the vicinity of pineal gland and suprasellar region. Microscopic examination showed the characteristic picture of a teratoma. The predominent component is immature neuroepithelium in the form of primitive neural tubules variably mature somatic tissure from other germ cell layers accompany the neuroepithelium. We report a case of congenital intracranial immature teratoma.

Two Cases of Stroke Occurred in Pregnant Women During the Period of Antepartum and Postpartum: A Case of Cerebral Infarction and the other Case of Cerebral Hemorrhage in Pregnant Women Both without any Manifestations of Preeclampsia or Eclampsia / 대한산부인과학회잡지

While maternal mortality rates due to obstetric causes have declined in recent years, maternal mortality rates due to non-obstetric causes have relatively increased. Among these, pregnancy related stroke is significant because it has the worst impact on both mother and the fetus. Stroke is the state of necrosis in brain tissues caused by perfusion disorder in the cerebral blood flow and pregnant or puerperal women are reported to have about 13-fold more risk of stroke compared to non-pregnant women. Pregnancy-related stroke must be differentiated from stroke in elderly patients, because it is different in pathophysiological etiologies and recurrence rates and also diagnostic and therapeutic methods may affect the fetal health status. In this article, we experienced one case of hemorrhagic stroke occurred in a normal pregnant woman with gestational age of 40 weeks and the other case with ischemic stroke in 33 gestational weeks, those both without any manifestation of preeclampsia or eclampsia.

The Application of Doppler Ultrasound in the Assessment of Fetal Weight / 대한산부인과학회잡지

OBJECTIVE: The objective of this study was to determine the relationship between the fetal doppler flow velocimetry and birth weight in low risk pregnancy population. METHODS: From December 1995 to May 1996, We prospectively performed doppler study in 254 uncomplicated, term pregnant women, who visited Pohang Hospital, Dongguk University. Using pulsed color doppler, we measured umbilical artery RI, middle cerebral artery RI and middle cerebral-umbilical artery RI ratio within one week before delivery. RESULTS: The result was that low birth weight group (below 2500gm) had very significant lationship with umbilical artery RI(P<0.01), middle cerebral artery RI(P<0.05) and middle cerebral-umbilical artery RI ratio(P<0.05), but there was no significant relationship in these blood flow indices between normal birth weight group (2501gm- 3999gm) and macrosomia group (above 4000gm). CONCLUSIONS: We concluded that application of doppler ultrasonopaphy in the assessment of fetal weight is somewhat helpful for identification of low birth weight, not for macrosomia.