Sa Ra Lee

Plasma levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in women with cervical neoplasia

OBJECTIVE The goal of this study was to investigate the relationship between plasma levels of insulin-like growth factors-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) and the risk for cervical intraepithelial neoplasia (CIN) and cervical cancer. METHODS Plasma levels of IGF-1 and IGFBP-3 of 44 cervical cancer patients, 82 CIN patients and 40 neoplasm-free patients were investigated. Then the associations of the plasma levels of IGF-1 and IGFBP-3 with cervical neoplasm or its clinicopathologic parameters were analyzed. RESULTS The mean IGF-1 concentrations were significantly different among the control, CIN, and cervical cancer groups; the levels were higher in the CIN group compared to the controls. According to the quartile category, the plasma IGF-1 level was significantly higher (p=0.0015) in the CIN group than in the controls. The IGFBP-3 level showed no association between the controls and CIN groups (p=0.842). Although the mean IGF-1/IGFBP-3 molar ratio had borderline significance (p=0.08) among the study population, the quartile comparison showed a significantly higher IGF-1/IGFBP-3 molar ratio in the CIN group compared to the control group (p=0.041). CONCLUSION Plasma levels of IGF-1 and the IGF-1/IGFBP-3 molar ratio might be useful for the development early detection of cervical lesions and used as an adjuvant diagnostic tool for cervical neoplasia after more larger scale research.

Black cohosh inhibits 17β-estradiol-induced cell proliferation of endometrial adenocarcinoma cells

Abstract This study was conducted to investigate the effect of black cohosh (BC) extract on the proliferation and apoptosis of Ishikawa cells. Ishikawa human endometrial adenocarcinoma cells were treated with or without BC (1, 5, 10 and 25 μM) and cell proliferation and cytotoxicity were measured by CCK-8 assays and flow cytometry analysis. Additionally, Ishikawa cells were treated with 17β-estradiol (E2), E2 + progesterone and E2 + BC (5 and 10 μM) and the effect of BC and progesterone on E2-induced cell proliferation was analyzed. BC decreased the proliferation of Ishikawa cells at a dose-dependent rate compared with the control group (p < 0.05). The proliferation of Ishikawa cells increased in the presence of E2, whereas the subsequent addition of progesterone or BC decreased proliferation to the level of the control group (p < 0.05). The inhibitory effect of BC on E2-induced cell proliferation was greater than the inhibitory effect of progesterone. In conclusion, BC induces apoptosis in Ishikawa cells and suppresses E2-induced cell proliferation in Ishikawa cells. BC could be considered a candidate co-treatment agent of estrogen-dependent tumors, especially those involving endometrial cells.

Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma

Objective Endometriosis is a common and recurring gynecologic disease which have afflicting females of reproductive age. We investigated the efficacy of long-term, post-operative use of dienogest for ovarian endometrioma. Methods We studied 203 patients who had undergone laparoscopic or robotic surgery for ovarian endometrioma, and were administrated dienogest 2 mg/day beginning in July of 2013, and continuing. We evaluated side effects of dienogest and ultrasonography was performed every 6 months to detect potential recurrence of endometrioma (2 cm) in these post-surgical patients. Results The follow-up observation periods were 30.2±20.9 months from surgery. The mean age was 34.1±7.2 years old. The mean diameter of pre-operative endometrioma was 5.6±3.0 cm2. One hundred eighty-two (89.7%) women received dienogest continuously for 12.0±7.1 months. Of the subjects, 21 (10.3%) patients discontinued dienogest at 2.4±1.0 months. The most common side effect when dienogest was discontinued was abnormal uterine bleeding. The occurrence rate of vaginal bleeding was 15.8%, a number which did not differ significantly in patients with/without post-operative gonadotropin releasing hormone agonist administration. The other side effects were gastrointestinal trouble including constipation, acne, headache, depression, hot flush, weight gain, and edema. However, no serious adverse events or side effects were documented and recurrent endometriomas were diagnosed in 3 patients (1.5%). Conclusion The data indicates that dienogest was both tolerable and safe for long-term use as prophylaxis in an effort to obviate the recurrence of ovarian endometrioma post-operatively, as well as potential need for surgical re-intervention.

Urinary incontinence is strongly associated with depression in middle-aged and older Korean women: Data from the Korean longitudinal study of ageing

OBJECTIVE To investigate the relationship between urinary incontinence (UI) and depression in middle-aged and older Korean women. STUDY DESIGN A total of 1116 participants diagnosed with UI among 7486 respondents were included in this study, using data from a well-established survey that investigated a nationally representative population: the Korean Longitudinal Study of Ageing (KLoSA). Computer-assisted personal interviewing was used to assess the status of UI and depression. Depression was assessed using the 10-item Center for Epidemiological Studies-Depression (CES-D 10) scale. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for depression were adjusted for age, household income level, marital status, education level, working status, smoking behavior, alcohol drinking behavior, exercise level, residence, and accompanying chronic diseases. RESULTS The proportion of patients with depression was significantly higher among women with UI (9.1%) than among women without UI (6.3%) (P<0.0001). The depression scores became worse with worsening UI symptoms (OR of better vs. same vs. worse, 1.00 vs. 1.51 vs. 2.15, respectively; P for trend=0.0001), with an increased number of days experiencing UI during the prior month during the 2 years of the panel study period (OR of none vs. 1≤days≤10days vs. 10days<were 1.00 vs. 2.15 vs. 4.36; P for trend=0.003). CONCLUSIONS Inadequately controlled and frequent UI is strongly associated with depression in middle-aged and older Korean women. The management of worsening UI may be of value as part of the assessment and management of depression.

Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort

Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons’ pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P <0.001). The ability to control the operating table height was the single factor most significantly associated with neck (P <0.001) and shoulder discomfort (P <0.001). Discomfort of the hand/digits was significantly associated with the trocar site (P = 0.035). The type of electrocautery activation switch and foot pedal were significantly related to surgeons’ foot and leg discomfort (P <0.001). In evaluating the co-occurrence of pain in 4 different sites (neck, shoulder, back, hand/digits), the neck and shoulder were determined to have the highest co-occurrence of pain (Spearman’s ρ = 0.64, P <0.001). These results provide guidance for identifying ergonomic solutions to reduce gynecological laparoscopic surgeons’ pain. Based on our results, we propose the use of an ergonomic surgical step stool to reduce physical pain related to performing laparoscopic operations.

Tenascin-X and leukemia inhibitory factor receptor are down-regulated in leiomyoma compared with normal myometrium

OBJECTIVE Uterine leiomyomas are the most common tumor of the uterus. But the molecular causes of uterine leiomyoma remain unclear. We conducted the current investigation in order to elucidate the molecular mechanisms in the development of uterine leiomyoma. METHODS We employed a new and accurate reverse transcription-polymerase chain reaction (RT-PCR) method that involved annealing control primers (ACPs) to identify the genes that are differently expressed in uterine leiomyoma. RESULTS Using 120 ACPs, we identified and sequenced 14 differently expressed genes (DEGs) in uterine leiomyoma compared with normal myometrium. Basic Local Alignment Search Tool (BLAST) searches were performed to examine the known functions of these genes associated with uterine leiomyoma. We confirmed differently expressed patterns in more cases using the RT-PCR method. We also detected two novel genes, Tenascin-X and Leukemia Inhibitory Factor Receptor (LIFR), which had not yet been reported to have any functions associated with uterine leiomyoma. RT-PCR confirmation shows that both of these two genes are down-regulated in uterine leiomyoma. CONCLUSION Our results suggest that Tenascin-X and LIFR may play a role in the development of uterine leiomyoma. Although further studies are required to establish the precise mechanisms with which these genes are involved in the genesis of uterine leiomyoma, the present research is significant in that it is the first study which detects down-regulated novel genes in uterine leiomyoma using the ACP system.

Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.

The role of gonadotrophin releasing hormone agonist for the treatment of scar endometriosis

목적 복벽절개 혹은 회음절개술 후 발생하는 절개반흔 자궁내막증 환자의 임상특징 및 가장 적합한 진단 및 치료법에 관해 알아보고자 하였다. 연구방법 1996년부터 2008년까지 본 병원에서 절개반흔 자궁내막증으로 종물절제술을 받은 30명의 환자를 대상으로 하여 의무기록을 바탕으로 후향적으로 분석하였다. 대상자의 연령, 분만력, 수술 과거력, 증상, 생리력, 종물의 특성, 수술 전 잠정진단명, 치료법과 재발에 대해 분석하였다. 결과 절개반흔 자궁내막증으로 확진된 환자 30명 중, 복벽절개반흔 자궁내막증 환자는 총 24명, 회음절개 반흔 자궁내막증 환자는 총 6명이었다. 증상은 대부분에서 주기적 통증을 동반하거나 동반하지 않는, 절개반흔 부위의 촉지되는 종물이었고, 마지막 수술 시점부터 증상발현까지의 기간은 평균 23.8개월이었다. 수술 전 영상검사를 시행한 경우는 14예였으나 절개반흔 자궁내막증으로 진단된 경우는 한 예도 없었다. 모든 경우에서 종물을 포함한 광범위한 절제를 시행받았고 성선자극호르몬유리호르몬작용제를 투여받은 경우는 13예였다. 재발은 4예(13.3%)에서 진단되었고 모든 경우가 수술 전 혹은 수술 후에 성선자극호르몬유리호르몬작용제를 투여받지 않은 경우에서였으나 통계적으로 유의한 차이는 없었다. 결론 본 연구결과에서 절개반흔 자궁내막증의 발생기전이 시술중의 자궁내막의 이식에 의한 것임을 뒷받침하고 있으며, 영상 검사가 진단에 크게 도움이 되지 않으며 병력 청취나 임상진찰에서 절개반흔 자궁내막증이 의심될 때 진단 및 치료를 위해 종물을 제거하는 것이 필요하다. 성선자극호르몬유리호르몬작용제를 수술 전후에 사용하는 것은 절개반흔 자궁내막증의 재발 억제에 도움이 될 가능성은 있겠으나 통계적으로 유의한 재발억제 효과는 없었다.