Transabdominal embryofetoscopy in 6 cases of first trimester prenatal diagnosis for congenital anomalies

Objective: To demonstrate the efficacy of first trimester embryofetoscopy for prenatal diagnosis of congenital anomalies in continuing pregnancies. Methods: Under ultrasound guidance, six patients at 12+6-14+6 weeks of gestation underwent endoscopic procedures. Indications included history of 2 recurrent major genetic syndromes, history of cleft lip/palate in 2 cases, each one of the patient itself and the previous fetus and each family history of syndactyly and polydactyly. A 1 mm semirigid fiberoptic endoscope with a 18 gauge examination sheath and a single-chip digital camera were used for transabdominal embryofetoscopy. Results: Excellent visualization of the external fetal anatomy was obtained in 83% of cases (5/6) with the duration of procedures ranging 15 to 40 minutes. A diagnosis of Meckel-Gruber syndrome was made at 13+1 weeks of gestation by visualizing postaxial polydactyly and an occipital encephalocele. Subsequently the pregnancy was terminated. Three full-term infants were delivered with no gross limb or facial abnormalities. Amniotic fluid leakage after the procedure occurred in 2 cases resulting in termination of pregnancy. Conclusion: Our experiences confirm the efficacy of embryofetoscopy for early diagnosis in the first trimester of pregnancy. Procedure-related risks are to be established by multicenter studies.ope

Laparoscopic management of asymptomatic ovarian steroid cell tumors, not otherwise specified: A case report and literature review

The steroid cell tumor, not otherwise specified, constitutes only 0.1% of ovarian malignancies and was asymptomatic in 3.3-25% In Korea, three reported cases of steroid cell tumors were endocrinologically symptomatic and were managed with laparotomy. However, there was no reports of such case without any endocrinologically symptoms. We present a 17 years old patient with huge pelvic mass that were managed with combined ultrasonographically guided drainage and laparoscopically excision and proven to be an asymptomatic steroid cell tumor of ovary, with brief review of literatureope

Two Cases of Ectopic Pregnancy Implanted in the Previous Cesarean Section Scar Treated with Dilatation and Evacuation after Vaginal Misoprostol

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. We present two cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with dilatation and evacuation after vaginal misoprostol.ope

Increased telomerase activity and human telomerase reverse transcriptase mRNA expression in the endometrium of patients with endometriosis

BACKGROUND: Endometriosis is considered a frequent, benign disease with the ability to undergo neoplastic processes. The aim of this study was to evaluate the limitless replication potential of the endometrium in patients with endometriosis by examining human telomerase reverse transcriptase (hTERT) mRNA expression and telomerase activity. METHODS: Endometrium samples from 30 endometriosis patients and 30 patients without endometriosis were obtained via endometrial biopsy. The expression of hTERT mRNA was determined by real-time RT-PCR assay, and telomerase activity was measured by telomerase repeat amplification protocol (TRAP) assay. RESULTS: The mean normalized hTERT (N hTERT) mRNA level was significantly higher in the endometriosis than in the control group (P = 0.013). The mean hTERT mRNA levels during the proliferative phase and during the secretory phase were higher in the endometriosis group than in the control group, although the difference was only significant for the secretory phase (P = 0.036). We found a prominent difference in endometrial telomerase activity between moderate-to-severe endometriosis and the control group (P = 0.048). The levels of hTERT mRNA and telomerase activity increased as the disease became more severe (P = 0.038, P = 0.016). CONCLUSIONS: This study showed the overexpression of hTERT mRNA and telomerase activity in the endometrium of endometriosis patients. These finding suggest that replication potential of endometrial cells may have an important role in the pathogenesis of endometriosis.ope

자궁내막증 환자의 자궁내막 조직에서 telomerase 활

Dept. of Medicine/석사[한글]목적 : 자궁내막증은 가임기 여성의 7-15%에서 발생하는 비교적 흔한 양성질환으로 종양화 과정과 유사한 특징을 가지고 있다. 주요 병리기전으로 생리혈의 역류현상과 유전적 또는 환경적 요인등이 중요하게 인식되었으나, 아직까지 자궁내막증의 착상 및 증식등에 관련해 정확히 밝혀진 바가 없다. 최근 연구에서 일부 유전자 또는 유전자 산물들이 자궁내막증 환자의 자궁내막 조직에서 발현이 증가되어있음이 보고되고 있다. human telomerase reverse transcriptase (hTERT) mRNA는 telomerase의 핵심 구성요소로서, telomerase와 함께 다양한 악성 조직에서 발현이 증가되어 있으며, 증식능 (replicative potential)과도 관련있는 것으로 알려져있다. 따라서, 본 연구에서는 정량적 hTERT mRNA와 telomerase 활성도를 이용해 자궁내막증이 있는환자에서 자궁내막 조직의 증식능을 살펴보고자 한다.대상 및 방법 : 본 연구는 수술중 자궁내막 조직검사를 이용해 채취한 자궁내막증 환자들의 자궁내막 조직과 자궁내막증이 없으며, 다른 자궁내막내의 병변이 없는 환자들의 정상 자궁내막 조직 각각 30개씩을 이용하였다. 각각의 군은 다시 생리주기와 자궁내막증 병기에 따라 분류하였다. hTERT mRNA의 발현은 Taq-Man fluorescence methodology에 근거한 real-time RT-PCR을 이용해 측정하였다. Telomerase activity 측정은 telomerase repeat amplification protocol (TRAP) assay를 이용하였다.결과 : hTERT mRNA의 발현양상을 살펴보면, 정상군에서는 80% (24/30)의 발현율을 보였으며, 자궁내막증군에서는 90% (27/30)가 발현되었다. 그 발현값은 정상군에 비해 자궁내막증군에서 통계적으로 유의하게 높았다 (p=0.004). Telomerase activity는 두 군 모두에서 90% (27/30)에서 관찰할 수 있었으며, 그 절대값은 정상군에 비해 자궁내막증군이 높았으나, 유의한 차이는 없었다. 그러나, 정상군과 자궁내막증 병기 III-IV 군만을 비교해 보았을때는 통계적으로 유의한 차이를 확인할 수 있었다 (p=0.048). 생리주기별로 증식기와 분비기로 각각 나누어 두 군의 hTERT mRNA 발현을 살펴보았을때, 자궁내막증 분비기의 값이 정상군의 분비기의 값에 비해 유의하게 증가되어 있었으며 (p=0.036), 증식기에서는 두 군간에 차이가 없었다. telomerase 발현도 역시 hTERT mRNA와 유사한 양상으로 나타났으나, 각 군간에 통계적으로 유의한 차이는 없었다. hTERT mRNA와 telomerase activity 모두 자궁내막증군에서 병기가 증가할 수록 그 값이 증가하는 양상을 관찰할 수 있었다 (p=0.038, p=0.016).결론 : 본 연구는 자궁내막증 환자의 자궁내막 조직에서 hTERT mRNA 및 telomerase activity가 정상군에 비하여 발현도가 증가되어있음을 보여주었다. 이는 자궁내막증의 자궁내막 조직이 정상조직과는 다른 증가된 증식능이 있음을 의미하는 것이고, 이것이 자궁내막증 병리기전에 관여할 것이라 사료된다. [영문]Introduction: Endometriosis is considered a frequent, benign disease with the ability to undergo neoplastic processes. Although retrograde menstruation theory, multiple genetic and environmental factors seem to be important, the critical factors that affect the implantation and propagation of endometriotic lesions are still largely unclear. Recent studies demonstrated that some genes or gene products were aberrantly expressed in the endometrium of endometriosis. Human telomerase reverse transcriptase (hTERT) mRNA is core functional components of telomerase activity. They have been detected in various cancers and are related with the proliferative potential. The aim of this study is to evaluate the limitless replication potential of eutopic endometrium in patients with endometriosis by examining quantitative human telomerase reverse transcriptase (hTERT) mRNA expression and telomerase activity.Materials and Methods: Endometrial tissues from 30 endometriosis patients (endometriosis group) and 30 patients without endometriosis (control group) were obtained via endometrial biopsy. Each group was subdivided and analyzed according to the menstrual phase and clinical disease stages.The expression of hTERT mRNA was determined by real-time RT-PCR assay based on Taq-Man fluorescence methodology. Telomerase activity was measured by telomerase repeat amplification protocol (TRAP) assay. The variables were analyzed by Student`s t-test, Kruskall-Wallis test and Pearson`s correlation coefficient.Results: The expressions of hTERT mRNA were detected in 24 of 30 (80%) normal group and in 27 of 30 (90%) endometriosis group. The normalized hTERT mRNA level was significantly higher in the endometriosis group than the control group (p=0.004). The hTERT mRNA level during the secretory phase in the endometriosis group was significantly higher than that of control group (p=0.036), although the difference was not significant during the proliferative phase. Telomerase activities were noted 90% in both group. We found a prominent difference of telomerase activity between moderate-to- severe endometriosis group and the control group (p=0.048). The level of hTERT mRNA and telomerase activity increased as the disease became more severe (p=0.038, p=0.016).Conclusion: This study showed the overexpression of hTERT mRNA and telomerase activity in the endometrium of endometriosis patients. This findings suggest that endometrial replication potential may have an important role in the pathogenesis of endometriosis.ope

The Effects of Raloxifene and Alendronate on Bone Metabolism in Postmenopausal Women with Osteoporosis

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Risk factors for pelvic organ prolapse

OBJECTIVES: To evaluate the risk factors for pelvic organ prolapse (POP) and to determine the relationship between these risk factors and stage or other components of POP. METHODS: 244 patients with primary POP and 314 women without POP were included. Age, parity, smoking, body mass index (BMI), menopause, and hormone replacement therapy (HRT) were investigated. RESULT: Independent risk factors for POP included age over 70, parity higher than 3, and menopause. Age, parity, menopause, and HRT were significantly associated with stage of POP. Genital hiatus (GH) and perineal body (PB) showed a significant positive and negative correlation with age and parity, respectively. Menopause and HRT were also associated with them. CONCLUSION: Age, parity and menopause are possible risk factors of POP and associated with the lengths of GH and PB in POP women. Further, these risk factors and HRT are significantly correlated with the severity of the disease.ope

Immunological and Antioxidant Effects of GCP (Genistein Concentrated Ploysaccharide) in Postmenopausal Women after Gynecological Cancer

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Evaluation of Adipokine Levels and Inflammatory Markers in Postmenopausal Women on Hormone Therapy

Recent research has demonstrated that adipose tissue is an active endocrine organ, which secretes various hormones, such as adiponectin, resistin, and leptin, referred to as adipo(cyto)kines. Adiponectin has anti- inflammatory, anti diabetic, and anti-atherogenic properties and resistin is known to increase insulin resistance. Adipokines are related to inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP), Interleukin (IL)-6, Tumor necrosis factor (TNF)-α. Adipose tissue is redistributed after menopause, and the risk of metabolic syndrome and cardiovascular events increases in postmenopausal women. Adipokines are considered to play an important role in this, but much is not known about the effects of menopause and hormone therapy on adipokines.The objectives of this study are to assess the changes of adipokines after menopause and effects of hormone therapy on adipokines and to evaluate the relations between cardiovascular risk factors and adipokines.Study subjects consisted of 36 premenopausal and 33 healthy, early menopausal women. 27 of the menopausal women received 6 months of hormone therapy. Initially body mass index (BMI), waist to hip ratio (WHR), and blood pressure (BP) were measured and lipid profile, fasting glucose, insulin, hs-CRP, IL-6, TNF-α, adiponectin, and resistin were assayed. Homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated.Total cholesterol, HDL cholesterol and fasting glucose levels in menopausal women were significantly higher than premenopausal women (169.39±30.04 vs. 197.55±35.37 mg/dL, 53.94±10.54 vs. 59.99±11.55 mg/dL, 4.75±0.36 vs. 5.04±0.46 mmol/L, P < 0.05), but not HOMA-IR index. Adiponectin was significantly raised in menopausal women (4.56 ± 2.42 vs. 7.76 ± 4.99 µg/mL, P < 0.05), but no difference was observed in levels of resistin, hs-CRP, TNF-a, and IL-6. Through multivariate regression analysis, hs-CRP and BMI were positively correlated, and adiponectin was positively correlated with age, and negatively correlated with BMI. TNF-α was significantly correlated with fasting glucose, and IL-6 with HOMA-IR index. After 6 months of hormone therapy, hs-CRP increased significantly (0.51±0.30 vs.1.22±1.52 mg/L, P < 0.05), but levels of adiponectin, resistin, TNF-a, and IL-6 were not altered.In conclusion, since adiponectin levels in healthy menopausal women increase significantly, it doesn’t seem to play a primary role in developing cardiovascular events and metabolic syndrome in menopausal women. Short term hormone therapy in menopausal women didn’t affect the levels of adipokines. Even though hs-CRP, an inflammatory marker, was increased after short-term hormone therapy, homocysteine and insulin levels went down and lipid profile was improved.ope

The Clinical Effects of Levonorgestrel-Releasing Intrauterine Device (MirenaⓇ) on Adenomyosis

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