Revised International Federation of Gynecology and Obstetrics (FIGO) staging systems in gynecologic malignancies

Revised International Federation of Gynecology and Obstetrics (FIGO) staging systems in gynecologic malignanciesope

Outcome of mid urethral sling procedures according to age

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 agesope

Postpartum urinary retention after vaginal delivery:

Objective: To evaluate the incidence of postpartum urinary retention (PUR) after vaginal delivery and to determine the risk factors for PUR. Methods: A retrospective case-control study of parturients with PUR after vaginal delivery between June 2007 and July 2008. Four controls, matched for date of delivery, were selected for each case in univariate and multivariate conditional logistic regression analyses. Results: There were 860 deliveries and 52 cases of PUR (incidence, 6%). All cases of PUR were managed with insertion of a Foley catheter with resolution before hospital discharge. Univariate analysis showed birth weight, increasing duration of the first and second stages of labor, biparietal diameter, perineal trauma, and epidural anesthesia to be significantly associated with PUR. Only perineal trauma remained statistically significant based on multivariate analysis. Conclusion: Perineal trauma was identified as the single most important associated risk factor for PUR after vaginal delivery. The findings of this study provide information for further exploration on how to reduce perineal trauma during vaginal deliveryope

Pregnancy outcomes in women with epilepsy using lamotrigine

Objective: The purpose of this study was to investigate pregnancy outcomes in women with epilepsy using lamotrigine (LTG). Methods: We retrospectively reviewed the medical records of all patients who had been diagnosed as epilepsy and gave live singleton births in Yonsei University Health System, Seoul, Korea, between February 1996 and December 2007. Nine patients who were not taking antiepileptic drugs (AEDs) were excluded from this study. We subdivided the enrolled patients into 2 groups; patients exposed to LTG and others exposed to other AEDs. Congenital malformation, spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were documented to evaluate the pregnancy outcomes. The statistical significance was defined as P<0.05. Results: 129 cases were found in all medical records. The overall risk of congenital malformations in the AED group was 6.2% (n=8), which included 4 cases to carbamazepine (CBZ) monotherapy, 1 to valproate (VPA) monotherapy, and 3 to VPA+CBZ polytherapy. Congenital malformations were significantly increased in the non-LTG groups than in the LTG group (8.7% vs. 0%, P=0.047), especially in non-LTG polytherapy group (20.0% vs. 0%, P=0.049). The rates of spontaneous abortion, small for gestational age, termination of pregnancy, intrauterine fetal death, preterm delivery, and adverse maternal outcomes were no significant differences between the two groups. Conclusion: This study demonstrates that administration of LTG in pregnant women with epilepsy could be more effective in decreasing teratogenicity than administration of other AEDs in polytherapyope

A rare case of primary adenosquamous carcinoma arising from ovary

Primary adenosquamous carcinoma of ovary is extremely rare malignancy. We report a case of primary adenosquamous carcinoma of the ovary which has not been reported in Korea before. The case of a 32 year old woman, evaluated for palpable abdominal mass is presented. Ultrasonography, abdomino-pelvic MRI, PET-CT were suggestive of a malignant neoplastic process. Surgical debulking operation including total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, para-aortic lymph node biopsy, total omentectomy, incidental appendectomy and low anterior resection of rectum were performed. Histopathology demonstrated primary adenosquamous carcinoma arising from the left ovary to the myometrium, serosa, rectal wall mass and omentum. The staging for ovarian tumor was consistent with FIGO stage IV. We present a case of this rare malignancy.ope

Transumbilical single port total Laparoscopic hysterectomy

Laparoscopic hysterectomy is currently considered the standard procedure in many patients who need hysterectomy. To reduce incisional morbidity and improve cosmetic outcomes we performed transumbilical single-port total laparoscopic hysterectomy using a special "single three-channel port" and standard laparoscopic tools with virtually no scar. We used an Alexis wound retractor (Applied Medical, CA, USA) and a surgical glove as the "single three-channel port". In this paper, we report four cases of total laparoscopic hysterectomy performed exclusively through an umbilical incision using a single three-channel port.ope

MicroRNA profiling of a CD133(+) spheroid-forming subpopulation of the OVCAR3 human ovarian cancer cell line.

BACKGROUND: Cancer stem cells (CSCs) are thought to be a source of tumor recurrence due to their stem cell-like properties. MicroRNAs (miRNAs) regulate both normal stem cells and CSCs, and dysregulation of miRNAs has an important role in tumorigenesis. Cluster of differentiation (CD) 133(+) and spheroid formation have been reported to be one of the main features of ovarian CSCs. Therefore, we determined the miRNA expression profile of a CD133(+) spheroid-forming subpopulation of the OVCAR3 human ovarian cancer cell line. METHODS: Initially, we confirmed the enrichment of the OVCAR3 CD133 subpopulation by evaluating in vitro anchorage-independent growth. After obtaining a subpopulation of CD133(+) OVCAR3 cells with > 98% purity via cell sorting, miRNA microarray and real-time reverse transcription-polymerase chain reaction (RT-PCR) were performed to evaluate its miRNA profile. RESULTS: We found 37 differentially expressed miRNAs in the CD133(+) spheroid-forming subpopulation of OVCAR3 cells, 34 of which were significantly up-regulated, including miR-205, miR-146a, miR-200a, miR-200b, and miR-3, and 3 of which were significantly down-regulated, including miR-1202 and miR-1181. CONCLUSIONS: Our results indicate that dysregulation of miRNA may play a role in the stem cell-like properties of ovarian CSCs.ope

자궁경부암에서 혈청 바이오마커로 Notch 신호경로를 통한 긴 비 암호화 RNA인 HOTAIR의 개발

Dept. of Medicine/박사HOTAIR is a long non-coding RNAs (lncRNA) that plays a role as an oncogenic molecule in cervical cancer. In this study, we investigated in detail the expression of serum HOTAIR, as well as its functions, in cervical cancer. Serum HOTAIR expression was assessed by qRT-PCR and the results were compared with clinicopathologic factors, including survival data. The effects of HOTAIR overexpression via lentiviral transfection were examined in SiHa cells and a xenograft model. The expression of HOTAIR in cervical cancer serum was significantly higher than in the control groups (P < 0.001), and this increase of expression was significantly associated with tumor size (P = 0.030), lymphovascular space invasion (P = 0.037), and lymph node metastasis (P = 0.043). In univariate analysis, disease free survival and overall survival in cervical cancer was significantly shorter in cases with high HOTAIR expression (hazard ratio [HR] = 4.27, 4.68 and P = 0.039, 0.031, respectively). HOTAIR overexpression in cervical cancer cells resulted in increase of cell proliferation and invasion in vitro, whereas HOTAIR knockdown inhibited these properties and increased apoptosis. In addition, in vivo experiments using HOTAIR overexpression clearly showed a strong inducer of tumor growth and a modulation of expression of epithelial-mesenchymal transition and Notch signaling pathway related genes, further suggesting that HOTAIR overexpression can promote cell proliferation and invasion. Taken together, increased serum HOTAIR expression is associated with poor survival outcome in cervical cancer, and HOTAIR may represent a useful therapeutic target in cervical cancer patients.ope

장액성 난소암에서 NANOG 발현의 예후적 중요성에 관한 연구

Dept. of Medicine/석사NANOG, a key transcription factor in embryonic stem cell self-renewal and pluripotency, plays an important role in solid tumor development. The purpose of this study was to evaluate the prognostic significance of NANOG expression in ovarian serous carcinoma. The expression of NANOG was evaluated in vitro in 6 ovarian carcinoma cell lines, paclitaxel-resistant SKOV3 (SKOV3-PR) cells, and SKOV3 spheroid cells with reverse transcription of mRNA, semi-quantitative polymerase chain reaction, and Western blotting. NANOG expression was also measured immunohistochemically in a tissue microarray containing ovarian tissues from 74 patients with ovarian serous carcinoma and 4 with ovarian serous cystadenoma. Each sample was scored based on signal intensity and proportion, and a score greater than 4 was considered “positive”. The correlation of NANOG expression with clinicopathological characteristics was assessed in terms of the following parameters: stage, age, cancer antigen-125, grade, ascites, lymph node status, and survival. NANOG mRNA expression was variable in different ovarian cancer cell lines. The mRNA level of NANOG was increased in the paclitaxel-resistant SKOV3 cells and SKOV3 spheroid cells compared to that in the SKOV3 cells. NANOG expression was positive in 21.6% of 74 ovarian serous carcinoma tissue samples, but none of the ovarian serous cystadenoma tissue samples were positive. Positive NANOG expression was associated with tumor grade (P = 0.073), but not with age, tumor stage, cytological positivity, nodal involvement, ascites, tumor size, or CA-125. The overall survival of the patients with positive NANOG expression was poorer than that of the patients with negative NANOG expression (P = 0.020). In patients with stage I or II disease, positive NANOG expression was independently associated with shorter overall survival compared with negative NANOG expression (40 vs. 120 months, respectively; P = 0.031). Positive NANOG expression is associated with poor prognosis of ovarian serous carcinoma. NANOG has potential as a predictor of survival for patients with ovarian carcinomas and may be involve in the mechanism of chemoresistance.restrictio

성경험이 없는 36세 여성 자궁경부에서 발생한 편평세포암 1예

The carcinoma of the uterine cervix in virgins is extremely rare. A 36-year-old virgin presented with a 4.8 x 2.2 cm sized endocervical mass with bleeding on sonography. Biopsy revealed a squamous cell carcinoma arising in the uterine cervix without human papilloma virus (HPV) DNA. Positron emission tomography revealed cervical cancer with multiple hematogenous lung metastases. After 3 cycles of preoperative chemotherapy, she underwent modified radical hysterectomy and 6 cycles of postoperative chemotherapy. After the treatment, complete resolution was obtained, and she has been followed without recurrence for 4 years. Although > 90% of cervical cancer is caused by HPV infection, we cannot completely deny the possibility of HPV negative cervical carcinoma.ope