Hyun-Joo Seol

The levels of circulating vascular endothelial growth factor and soluble Flt-1 in pregnancies complicated by preeclampsia

To evaluate the role of vascular endothelial growth factor (VEGF) in the pathogenesis of preeclampsia, we measured total VEGF, free VEGF and soluble Flt-1 (sFlt-1) concentrations and determined their relationships. Maternal serum samples were collected from 20 patients with preeclampsia and 20 normotensive women with uncomplicated pregnancies matched with the patients with preeclampsia for gestational age and parity. The serum concentrations of total VEGF (2.39±0.75 vs. 0.28±0.14) and sFlt-1 (934.5±235.5 vs. 298.0±161.2) were significantly increased in the patients with preeclampsia compared to the women with uncomplicated pregnancies. However the serum concentration of free VEGF (21.5±6.3 vs. 134.0±16.3) was lower in patients with preeclampsia. There was a positive correlation between the serum concentrations of total VEGF and sFlt-1 with systolic and diastolic blood pressure, respectively. There was a negative correlation between the serum concentration of free VEGF and systolic and diastolic blood pressure. There was a strong negative correlation between free VEGF and sFlt-1 concentrations. In conclusion, we found VEGF and sFlt-1 were related to the pathogenesis of preeclampsia. Although reduced concentrations of free VEGF might interfere with endothelial cell function and survival, further studies are required to clarify its specific role in the pathogenesis of preeclampsia.

Epidemiologic characteristics of cervical cancer in Korean women

Cervical cancer is the most common female genital tract malignancy in Korean women. Although age-standardized cancer incidence rate of cervical cancer has decreased from 18.6 per 100,000 women in 1999 to 12.3 per 100,000 women in 2010 in Korea with widespread routine screening, several epidemiologic characteristics are still present. Incidence of cervical cancer still varies according to geographic area, and a significant portion of cases are detected at a locoregionally advanced stage, without significant improvement of five-year survival rate.2014-01-15 Cervical screening techniques such as the Pap smear should be the gold standard strategy to decrease incidence and to improve the survival outcomes of patients with cervical cancer. In addition, screening programs for cervical cancer should be designed, organized and directed within the context of a nationwide program for cancer control.

Changes in the Cesarean Section Rate in Korea (1982-2012) and a Review of the Associated Factors

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary. Graphical Abstract

Correlation between FDG uptake by PET/CT and the expressions of glucose transporter type 1 and hexokinase II in cervical cancer.

Background The aim of this study was to explore the association between 2-deoxy-2-F18-fluoro-D-glucose uptake and the expressions of glucose transporter type 1 (GLUT-1) and hexokinase II (HK-II) in the lymph nodes of patients with cervical cancer. Methods This prospective study included 20 women with International Federation of Gynecology and Obstetrics stage IB to stage IIA cervical cancer who underwent positron emission tomography (PET)–computed tomography (CT) (PET/CT) before surgical treatment. In 333 dissected lymph nodes (LNs) obtained, we examined the size, tumor involvement, and expressions of GLUT-1 and HK-II. These characteristics were compared with PET/CT and pathological findings. Results Pathological analysis found that 21% (70) of the 333 surgically dissected LNs were metastatic. Positron emission tomography/CT detected metastasis with 22.8% sensitivity and 98.5% specificity. The levels of GLUT-1 and HK-II expression in false-positive LNs were higher than those in pathologically confirmed negative nodes (P = 0.015 and P = 0.001, respectively). In metastatic LNs, PET/CT-positive nodes were significantly different from PET/CT-negative nodes in mean size (P = 0.043), tumor involvement (P = 0.008), and proportion of GLUT-1–positive tumor cells (P = 0.042). Conclusions Our results indicate that overexpression of GLUT-1 and HK-II may be related to 2-deoxy-2-F18-fluoro-D-glucose uptake in false-positive tissues on PET/CT. In metastatic lymph nodes, the ability of PET/CT to detect cancer may depend on tumor involvement, lymph node size, and GLUT-1 expression.

Hepatitis A virus infection during pregnancy in Korea: Hepatitis A infection on pregnant women.

Objective Although there is a large body of data on acute hepatitis A virus (HAV) worldwide, data regarding the occurrence of HAV during pregnancy is limited. It is commonly acknowledged that HAV is not associated with severe outcomes or complications during pregnancy. In contrast, there are several reported cases of vertical HAV transmission. Moreover, it has been recently reported that HAV infection during pregnancy is associated with gestational complications. In Korea, the incidence of HAV infection has increased from 317 cases in 2002 to 13,117 cases in 2009. However, HAV infection during pregnancy is rarely reported in Korea. Methods This study was conducted as a retrospective cohort series of pregnant women presenting to Korea University Medical Center between January 2000 and October 2009 in whom a diagnosis of HAV infection was made. Results During study period, there were 12 cases of HAV in pregnant women, including two cases with preterm contraction, two cases with cholestatic hepatitis, and one case with fetal ascites and intra-abdominal calcification. Conclusion HAV infection during pregnancy is associated with high prevalence of maternal and fetal complications. Because the incidence of HAV infection in women of reproductive age is increasing, a further focus on preventing HAV infection during pregnancy is warranted.

Genetic Polymorphism of PRKCDBP is Associated with an Increased Risk of Endometrial Cancer

PRKCDBP is a putative tumor suppressor located at 11p15.4, where frequent genomic loss has been observed in human cancers. We explored the possible association between an intra-exonic single nucleotide polymorphism (SNP), rs1051992, that results in a Leu to Pro substitution, and risk for endometrial carcinogenesis. We assessed the genotype of rs1051992 in endometrial cancer tissues from 147 patients and normal endometrial tissue from 191 healthy individuals by restriction endonuclease PvuII-based genotyping. Allele frequencies in the cancer specimens were compared with those in the healthy controls. We also evaluated the association between polymorphisms at this locus and histopathological features of endometrial cancer.

2014 First-trimester ultrasound forum from the Korean Society of Ultrasound in Obstetrics and Gynecology

A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum.

Spontaneous bilateral tubal pregnancy following hysterosalpingography

We present a case of spontaneous bilateral tubal pregnancy in a woman following hysterosalpingography (HSG), which to our knowledge has not been reported previously. A 29-year-old woman, gravid 0, was referred to our clinic for treatment of left tubal pregnancy after 8 weeks of amenorrhea. Seven weeks prior to that, the patient underwent HSG for evaluation of tubal patency and left tubal obstruction was diagnosed. Initially, except for minimal tenderness over the left adnexa, physical examination was unremarkable. The initial result of a quantitative test for b-human chorionic gonadotropin (bhCG) was 1,584 mIU/ml, but 48 h later this value was 1,886 mIU/ml. The patient’s condition remained stable. Transvaginal ultrasound revealed no evidence of an intrauterine pregnancy, no fluid in the cul-de-sac and an approximately 3 cm-sized ovarian echo at both adnexa. The left tube had a complex structure measuring 2.8 9 1.5 9 1.8 cm. The patient was counseled, and she opted for methotrexate (MTX) therapy, 50 mg/m intramuscularly. Serum b-hCG levels were found to be 1,857 mIU/ml on day 2 after treatment, 1,500 mIU/ml on day 5, and 1,638 mIU/ml on day 7. The patient’s hCG level did not drop, and a second cycle of MTX was injected; however, b-hCG was still 1,405 mIU/ml on day 4 after the second cycle of treatment. We decided that surgical intervention was necessary. Laparoscopy revealed an approximately 3 cm-sized unruptured left ampullary pregnancy, and a left salpingostomy was performed to remove it. Inspection of the right tube revealed an approximately 1 cm-sized bulging area in the ampullary region (Fig. 1). Linear salpingostomy was performed. Pathology confirmed that conceptuses had been removed from both the right and left tubes. Followup b-hCG was 247 mIU/ml on postoperative day 1. Bilateral tubal pregnancy is a rare clinical entity. The reported instance is 1 in 2,00,000 pregnancies [1]. Bilateral tubal pregnancies are more common after assisted reproductive technology, such as ovulation induction [2], in vitro fertilization and embryo transfer (IVF-ET) [3–5], or intracytoplasmic sperm injection (ICSI) [6], than they are after spontaneous conception [1]. The risk factors related to spontaneous ectopic pregnancy are well known, such as pelvic inflammatory disease, endometriosis, previous surgery and its sequelae, and infertility. Spontaneous bilateral tubal pregnancy is also related to the factors previously mentioned, along with double spontaneous ovulation. HSG is a commonly performed diagnostic investigation to assess tubal patency in infertility patients. It has potential therapeutic effects on subfertility [7]. There is evidence for the effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention; however, there is no significant association between this procedure and miscarriage or ectopic pregnancy [7]. The diagnosis of bilateral ectopic pregnancy can be achieved by finding chorionic villi in surgical specimens obtained from both tubes [1]. There can be great difficulty in diagnosing this condition before surgery, however, in which the level of b-hCG is not particularly useful. Indeed, most often, contralateral ectopic pregnancy is asymptomatic or difficult to differentiate from pelvic pain secondary to medical treatment or to controlled ovarian hyperstimulation [6]. H.-J. Seol S.-Y. Tong (&) Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, South Korea e-mail: sytong@hanmail.net

Rethinking surgical concepts for early cervical cancer

Radical hysterectomy and pelvic with/without para-aortic lymphadenectomy have been widely accepted as the preferred surgical treatments in patients with early-stage cervical cancers, including those with International Federation of Gynecology and Obstetrics (FIGO) stages IB–IIA. During this procedure, gynecologic oncologists aim to remove malignant lesions in the cervix, with a radial safety margin of 1–2 cm in the vagina and mesometrium. In cases of early cervical cancer where resection margins are very close to the bladder and rectum, most surgeons do not perform resections because of the lack of adequate safety margins. Furthermore, surgeons sometimes confront microscopic parametrial involvement in the final pathology report after radical surgery. Even in cases with histologically confirmed clear resection margins, adjuvant radiation therapy has usually been administered to improve locoregional control of microscopic parametrial involvement. Unfortunately, this bimodal therapy strategy increases treatment-related morbidity and has uncertain effects on overall survival.

The practice patterns of second trimester fetal ultrasonography: A questionnaire survey and an analysis of checklists.

Objective To analyze practice patterns and checklists of second trimester ultrasonography, and to investigate management plans when soft markers are detected among Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) members. Methods An internet-based self-administered questionnaire survey was designed. KSUOG members were invited to the survey. Checklists of the second trimester ultrasonography were also requested. In the questionnaire survey, general practice patterns of the second trimester ultrasonography and management schemes of soft markers were asked. In the checklists analysis, the number of items were counted and also compared with those recommended by other medical societies. Results A total of 101 members responded. Eighty-seven percent routinely recommended second trimester fetal anatomic surveillance. Most (91.1%) performed it between 20+0 and 23+6 weeks of gestation. Written informed consents were given by 15.8% of respondents. Nearly 60% recommended genetic counseling when multiple soft markers and/or advanced maternal age were found. Similar tendencies were found in the managements of individual soft markers. However, practice patterns were very diverse and sometimes conflicting. Forty-eight checklists were analyzed in context with the number and content of the items. The median item number was 46.5 (range, 17 to 109). Of 49 items of checklists recommended by International Society of Ultrasound in Obstetrics and Gynecology and/or American Congress of Obstetricians and Gynecologists, 14 items (28.6%) were found in less than 50% of the checklists analyzed in this study. Conclusion Although general practice patterns were similar among KSUOG members, some of which were conflicting, and there is a need for standardization of the practice patterns and checklists of second trimester ultrasonography, which also have very wide range of spectrum.