To compare clinical outcomes after fresh embryo transfer on laser-assisted zona pellucida opening (LAO) versus thinning (LAT) according to maternal age in patients with repeated implantation failure (RIF). A retrospective study of 509 (n = 458 patients) in vitro fertilization/intracytoplasmic sperm injection cycles was investigated from January 2013 to July 2017. We compared whether LAT and LAO affect the clinical outcomes in young maternal age (YMA, <38 years) and old maternal age (OMA, ≥38 years) patient groups with ≥2 of RIF. The cycles with an oocyte donation, oocyte activation, genetic diagnosis, and that used surrogate mothers were excluded. Participants were divided into 4 groups according to maternal age and the two types of laser-assisted hatching (YMA: LAT, n = 119 vs. LAO, n = 179 and OMA: LAT, n = 72 vs. LAO, n = 139). LAO was opened using 3-4 laser shot in the zona pellucida. The laser thinning was performed by making 3-4 holes without reaching the inner membrane at a depth of 60%-80% of the zona pellucida thickness. Laser-assisted hatching was performed 2 hours before the embryo transfer. The characteristics of patients did not differ significantly among the groups (p > 0.05), with the exception of mixed factor infertility, which was more common in the LAT group than in the LAO group among patients <38 years of age (10.1% vs. 2.8%, p = 0.008). We also observed similar rates of clinical pregnancy (27.7% vs. 24.6%, p = 0.543; 16.7% vs. 18.7, p = 0.715), ongoing pregnancy (22.7% vs. 21.8%, p = 0.854; 8.3% vs. 15.1, p = 0.163), abortion (18.2% vs. 11.4%, p = 0.397; 50.0% vs. 19.2, p = 0.052), implantation (17.2% vs. 16.5%, p = 0.811; 11.1% vs. 11.2, p = 0.990), and twin pregnancy (5.0% vs. 5.6%, p = 0.498; 0.0% vs. 2.2, p = 0.553) between LAT and LAO in the YMA or the OMA group. Clinical outcomes were similar between LAT and LAO in the YMA or the OMA group. However, the OMA group who underwent LAO tended to have a lower abortion rate. Further study is necessary to confirm these results in a larger population.

ObjectiveIt is recommended that thyroid-stimulating hormone (TSH) level of early pregnant women is maintained below than 2.5 mIU/L. However, the reference value of the preconception TSH has not been established. The purpose of this study is to determine whether the preconception TSH level is affecting the pregnancy outcome in women undergoing in vitro fertilization (IVF).DesignRetrospective study.Materials and MethodsSix hundred sixty-three infertile patients with normal range TSH level who underwent IVF for the first time were studied from June 2012 to December 2014. The study subjects were categorized in two groups according to their preconception TSH level; one with TSH < 2.5 mIU/L and the other with TSH ≥ 2.5 mIU/L. We compared the clinical pregnancy rates, live birth rates, chemical abortion rates and miscarriage rates in two group.ResultsFour hundred sixty patients of the study subjects had serum TSH level < 2.5 mIU/L and 203 patients ≥ 2.5 mIU/L. There were no statistically significant differences in age, periods of infertility, BMI, the number of metaphase II (MII) oocytes at ovum pick-up day, the number of transferred embryos and anti-müllerian hormone (AMH) level of patients between the study groups. The clinical pregnancy rate in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 40.90% and 42.90% respectively (p value= 0.632). The live birth rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 33.5% and 35% respectively (p value= 0.707). The chemical abortion rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 11.1% and 8.4% respectively (p value= 0.289). The miscarriage rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 18.1% and 18.4 % respectively (p value= 0.951).ConclusionsThere was no significant difference between the IVF outcomes of the normal-TSH-level groups of <2.5 mIU/L and ≥ 2.5 mIU/L. ObjectiveIt is recommended that thyroid-stimulating hormone (TSH) level of early pregnant women is maintained below than 2.5 mIU/L. However, the reference value of the preconception TSH has not been established. The purpose of this study is to determine whether the preconception TSH level is affecting the pregnancy outcome in women undergoing in vitro fertilization (IVF). It is recommended that thyroid-stimulating hormone (TSH) level of early pregnant women is maintained below than 2.5 mIU/L. However, the reference value of the preconception TSH has not been established. The purpose of this study is to determine whether the preconception TSH level is affecting the pregnancy outcome in women undergoing in vitro fertilization (IVF). DesignRetrospective study. Retrospective study. Materials and MethodsSix hundred sixty-three infertile patients with normal range TSH level who underwent IVF for the first time were studied from June 2012 to December 2014. The study subjects were categorized in two groups according to their preconception TSH level; one with TSH < 2.5 mIU/L and the other with TSH ≥ 2.5 mIU/L. We compared the clinical pregnancy rates, live birth rates, chemical abortion rates and miscarriage rates in two group. Six hundred sixty-three infertile patients with normal range TSH level who underwent IVF for the first time were studied from June 2012 to December 2014. The study subjects were categorized in two groups according to their preconception TSH level; one with TSH < 2.5 mIU/L and the other with TSH ≥ 2.5 mIU/L. We compared the clinical pregnancy rates, live birth rates, chemical abortion rates and miscarriage rates in two group. ResultsFour hundred sixty patients of the study subjects had serum TSH level < 2.5 mIU/L and 203 patients ≥ 2.5 mIU/L. There were no statistically significant differences in age, periods of infertility, BMI, the number of metaphase II (MII) oocytes at ovum pick-up day, the number of transferred embryos and anti-müllerian hormone (AMH) level of patients between the study groups. The clinical pregnancy rate in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 40.90% and 42.90% respectively (p value= 0.632). The live birth rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 33.5% and 35% respectively (p value= 0.707). The chemical abortion rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 11.1% and 8.4% respectively (p value= 0.289). The miscarriage rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 18.1% and 18.4 % respectively (p value= 0.951). Four hundred sixty patients of the study subjects had serum TSH level < 2.5 mIU/L and 203 patients ≥ 2.5 mIU/L. There were no statistically significant differences in age, periods of infertility, BMI, the number of metaphase II (MII) oocytes at ovum pick-up day, the number of transferred embryos and anti-müllerian hormone (AMH) level of patients between the study groups. The clinical pregnancy rate in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 40.90% and 42.90% respectively (p value= 0.632). The live birth rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 33.5% and 35% respectively (p value= 0.707). The chemical abortion rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 11.1% and 8.4% respectively (p value= 0.289). The miscarriage rates in the group of patients with TSH < 2.5 mIU/L and those with ≥ 2.5 mIU/L were 18.1% and 18.4 % respectively (p value= 0.951). ConclusionsThere was no significant difference between the IVF outcomes of the normal-TSH-level groups of <2.5 mIU/L and ≥ 2.5 mIU/L. There was no significant difference between the IVF outcomes of the normal-TSH-level groups of <2.5 mIU/L and ≥ 2.5 mIU/L.

To investigate an influence of abstinence period on clinical outcomes in fresh embryo transfer after intracytoplasmic sperm injection (ICSI). A retrospective cohort study of 122 women who underwent 131 ICSI cycles from January 2013 to February 2015. All women who underwent long or antagonist protocol with fresh embryo transfer after ICSI were analyzed. Cycles were divided into two groups; 2-4 days of abstinence (Group 1, n=67) and 5-7 days of abstinence (Group 2, n=64). Cycles with poor responder, advanced maternal age (≥38 years), frozen sperm, and surgically retrieved sperm were excluded. Day3 top-quality embryos were defined as those having even blastomeres and no fragments. We compared the rates of day3 top-quality embryos, implantation, chemical pregnancy, clinical pregnancy, and ongoing pregnancy between group 1 and group 2. There were no significant differences between group 1 and group 2 regarding mean maternal age (32.6 ± 2.9 vs. 32.8 ± 2.6, p=0.590), mean paternal age (35.2 ± 3.5 vs. 34.7 ± 4.0, p=0.509), mean number of previous IVF cycles (0.3 ± 0.5 vs. 0.2 ± 0.4, p=0.105), mean number of retrieved oocytes (13.1 ± 4.2 vs.14.4 ± 6.5, p=0.170), maturation rate (90.4% vs. 88.1%, p=0.084), fertilization rate (77.5% vs. 72.9%, p=0.102), and mean number of transferred embryos (2.2 ± 0.5 vs. 2.3 ± 0.6, p=0.223). We also observed similar rates of day3 top-quality embryos (11.4% vs. 7.3%, p=0.121), implantation (28.3% vs. 22.6%, p=0.266), chemical pregnancy (49.3% vs. 48.4%, p=0.926), clinical pregnancy (44.8% vs. 43.8%, p=0.906), and ongoing pregnancy (41.8% vs. 35.9%, p=0.492) in group 1 and group 2. Our data showed that 2-7 days of abstinence recommended by the WHO did not influence on the rates of day3 top-quality embryos, and clinical outcomes in fresh embryo transfer after ICSI.

To investigate the correlation between the change of biomarker levels including serum tissue inhibitor of metalloproteinases-1 (TIMP-1), urokinase plasminogen activator receptor (uPAR), vascular endothelial growth factor (VEGF), and epidermal growth factor receptor (EGFR) and the response to neoadjuvant concurrent chemoradiation (NACCRT) in locally advanced rectal cancer (LARC). From 2007 to 2009, a total of 45 clinical TNM stage II or III patients was enrolled in this prospective study. NACCRT consisted of 50.4 Gy in 1.8 Gy daily fraction of pelvic radiotherapy (RT) with concurrent 5-fluorouracil (425 mg/m2) and leucovorin (20 mg/m2) bolus intravenous chemotherapy on week 1 and 5 of RT. Radical surgery was performed 4-6 weeks after NACCRT. Pre- and post-RT serum levels of biomarkers were assessed using ELISA and were transformed to log10. Pathologic response was evaluated according to the Mandard regression grading system (MG) and tumor downstaging (DS). DS was defined as a reduction of TNM stage grouping. We analyzed the relation between biomarkers and response to NACCRT using paired samples T-test and chi-square test. The median follow-up duration was 21 months (range 15 to 30). All patients have survived and locoregional and distant recurrences occurred in 3 (6.6%) and 11 (24.4%) patients, respectively. The median disease free survival time was 21 months (range 4 to 29). DS occurred in 33 patients (73.3%), and tumors showed a complete pathological response (pCR) in 5 patients (11.1%). Patients were divided into 2 groups according to the MG: 15 patients (33.3%) in group A (Grade 1 or 2) and 30 patients (66.7%) in group B (Grade 3 to 5). In patients without pCR, without DS, and in MG group B, mean TIMP-1, uPAR and VEGF levels were significantly increased after NACCRT: 2.28 ± 0.15 to 2.32 ± 0.09 (p = 0.019), 2.26 ± 0.15 to 2.34 ± 0.10 (p = 0.044), and 2.28 ± 0.14 to 2.34 ± 0.09 (p = 0.007) in TIMP-1; 0.42 ± 0.20 to 0.48 ± 0.24 (p = 0.046), 0.49 ± 0.18 to 0.64 ± 0.19 (p = 0.001), and 0.43 ± 0.19 to 0.51 ± 0.23 (p = 0.006) in uPAR; 2.54 ± 0.42 to 2.64 ± 0.31 (p = 0.038), 2.34 ± 0.52 to 2.58 ± 0.28 (p = 0.032), and 2.59 ± 0.36 to 2.70 ± 0.29 (p = 0.033) in VEGF, respectively. Mean EGF level was significantly decreased in patients without pCR, without DS, and in MG group B. In subgroup analysis, a group of patients with increased VEGF and decreased EGFR includes significantly more patients of MG group B than the other group (93.8% vs. 51.7%, p = 0.004). There were significantly less patients with DS in a group of patients with decreased EGFR and increased uPAR than the other group (51.4% vs 91.7%, p = 0.003). The increase of the serum levels of TIMP-1, uPAR, and VEGF and the decrease of EGFR was related to poor response to NACCRT for LARC.

Purpose/Objective(s)To determine whether cyclooxygenase-2 (COX-2) overexpression in surgical specimen was an indicator of prognosis in patients with locally advanced rectal cancer undergoing surgical resection and postoperative adjuvant chemoradiation.Materials/MethodsSeventy two patients with locally advanced rectal cancer who were treated with surgical resection and postoperative adjuvant chemoradiation between 2000 and 2001 were divided into two groups according to their COX-2 levels in surgical specimen through immunohistochemical study: the COX-2 (+) group (n = 27) and the COX-2 (-) group (n = 45). The specimens were graded based on the intensity and extent of staining. The correlations between COX-2 overexpression and clinicopathological parameters, patterns of failure and survival were analyzed. Prognostic factors influencing patient survival were analyzed.ResultsMedian follow-up period was 65 months. COX-2 overexpression was observed in 37.5% of patients. The COX-2 (+) group showed significantly higher treatment failure rates compared with the COX-2 (-) group. Pelvic failure rates were 25.9% for the COX-2 (+) group and 6.7 % for the COX-2 (-) group (p = 0.02). Distant metastases were observed in 48.1% of the COX-2 (+) group and 17.8% of the COX-2(-) group (p = 0.006). Five-year actuarial overall survival rates were 54.1 % for the COX-2 (+) group and 85.6% for the COX-2 (-) group (p = 0.03). Five-year disease free survival rates were 46.8% for the COX-2 (+) group and 76.0% for the COX-2 (-) group (p = 0.02). Univariate and multivariate analyses showed that COX-2 overexpression was an independent prognostic factor that surpassed other well-known clinicopathological parameters.ConclusionsCOX-2 overexpression in surgical specimen can be used as a potent molecular risk factor in patients with locally advanced rectal cancer treated with surgical resection and postoperative adjuvant chemoradiation. COX-2 status may help individualization of treatment plans for rectal cancer patients. Purpose/Objective(s)To determine whether cyclooxygenase-2 (COX-2) overexpression in surgical specimen was an indicator of prognosis in patients with locally advanced rectal cancer undergoing surgical resection and postoperative adjuvant chemoradiation. To determine whether cyclooxygenase-2 (COX-2) overexpression in surgical specimen was an indicator of prognosis in patients with locally advanced rectal cancer undergoing surgical resection and postoperative adjuvant chemoradiation. Materials/MethodsSeventy two patients with locally advanced rectal cancer who were treated with surgical resection and postoperative adjuvant chemoradiation between 2000 and 2001 were divided into two groups according to their COX-2 levels in surgical specimen through immunohistochemical study: the COX-2 (+) group (n = 27) and the COX-2 (-) group (n = 45). The specimens were graded based on the intensity and extent of staining. The correlations between COX-2 overexpression and clinicopathological parameters, patterns of failure and survival were analyzed. Prognostic factors influencing patient survival were analyzed. Seventy two patients with locally advanced rectal cancer who were treated with surgical resection and postoperative adjuvant chemoradiation between 2000 and 2001 were divided into two groups according to their COX-2 levels in surgical specimen through immunohistochemical study: the COX-2 (+) group (n = 27) and the COX-2 (-) group (n = 45). The specimens were graded based on the intensity and extent of staining. The correlations between COX-2 overexpression and clinicopathological parameters, patterns of failure and survival were analyzed. Prognostic factors influencing patient survival were analyzed. ResultsMedian follow-up period was 65 months. COX-2 overexpression was observed in 37.5% of patients. The COX-2 (+) group showed significantly higher treatment failure rates compared with the COX-2 (-) group. Pelvic failure rates were 25.9% for the COX-2 (+) group and 6.7 % for the COX-2 (-) group (p = 0.02). Distant metastases were observed in 48.1% of the COX-2 (+) group and 17.8% of the COX-2(-) group (p = 0.006). Five-year actuarial overall survival rates were 54.1 % for the COX-2 (+) group and 85.6% for the COX-2 (-) group (p = 0.03). Five-year disease free survival rates were 46.8% for the COX-2 (+) group and 76.0% for the COX-2 (-) group (p = 0.02). Univariate and multivariate analyses showed that COX-2 overexpression was an independent prognostic factor that surpassed other well-known clinicopathological parameters. Median follow-up period was 65 months. COX-2 overexpression was observed in 37.5% of patients. The COX-2 (+) group showed significantly higher treatment failure rates compared with the COX-2 (-) group. Pelvic failure rates were 25.9% for the COX-2 (+) group and 6.7 % for the COX-2 (-) group (p = 0.02). Distant metastases were observed in 48.1% of the COX-2 (+) group and 17.8% of the COX-2(-) group (p = 0.006). Five-year actuarial overall survival rates were 54.1 % for the COX-2 (+) group and 85.6% for the COX-2 (-) group (p = 0.03). Five-year disease free survival rates were 46.8% for the COX-2 (+) group and 76.0% for the COX-2 (-) group (p = 0.02). Univariate and multivariate analyses showed that COX-2 overexpression was an independent prognostic factor that surpassed other well-known clinicopathological parameters. ConclusionsCOX-2 overexpression in surgical specimen can be used as a potent molecular risk factor in patients with locally advanced rectal cancer treated with surgical resection and postoperative adjuvant chemoradiation. COX-2 status may help individualization of treatment plans for rectal cancer patients. COX-2 overexpression in surgical specimen can be used as a potent molecular risk factor in patients with locally advanced rectal cancer treated with surgical resection and postoperative adjuvant chemoradiation. COX-2 status may help individualization of treatment plans for rectal cancer patients.

목적: 난소난관농양 환자의 혈청 CA 125를 포함한 ESR, CRP 수치 및 초음파 소견과 그 외 영향을 미치는 인자들을 조사, 분석하여 난소난관농양의 진단 및 수술적 중재 여부를 예측하고 추적검사를 할 수 있는 지표로서의 유용성을 알아보고자 하였다. 방법: 난소난관농양으로 입원한 총 65예의 난소난관농양 환자 중 보존적 치료에 성공한 29예를 보존적 치료군으로 설정하였고, 보존적 치료에 실패하여 침습적인 치료를 추가한 36예를 수술적 치료군으로 설정하였다. 연구 대상자들의 의무기록을 검토하여 후향적 연구를 시행하였다. 결과: 입원 시 측정한 혈청 CA 125를 비롯한 ESR, 농양의 크기는 난소난관농양의 치료에서 수술적 중재 여부 예측에 의미 있는 인자로 나타났다. 난소난관농양의 수술적 중재를 결정짓는 진단적 가치가 높은 인자는 ESR, 농양의 크기, CA 125순이며 이들의 새로운 양성 기준은 각각 36.5 mm/h, 4.2 cm, 68.3 U/ml이었다. CA 125 및 ESR의 민감도는 중증으로 진행된 병변에서 유의하게 증가하여 중증의 진행된 병변에서 진단적 가치가 있었다. 임상 경과의 추적 지표로서 CRP는 10일 내에 치료 경과 판정을 위한 추적검사로서 의의가 있으나 CA 125가 정상화되기까지 소요된 시간은 평균 51.5일로 CA 125는 단기간의 추적검사로서 부적절하다고 나타났다. 결론: 난소난관농양에서 CA 125, ESR 및 농양의 크기는 수술적 중재를 결정짓는 예측 인자이고 CA 125 및 ESR은 중증의 진행된 병변에서 진단적 가치가 있으나 CA 125는 임상 경과에 대한 단기간의 추적 지표로서 부적절함을 알 수 있다. 이를 바탕으로 난소난관농양의 진단 및 치료 기준안을 만들고 이에 따라 치료와 추적 검사를 시행한다면 치료 실패율을 현저히 낮추고 합병증과 재발을 줄이게 될 것이다.

OBJECTIVE:To investigate whether the -1562C>T, R279Q, P574R, and R668Q polymorphisms of the matrix metalloproteinase-9 (MMP-9) gene are related to endometriosis. DESIGN:Case-control study. SETTING:University-based hospital in Korea. PATIENT(S):Patients with endometriosis stage III/IV (n = 225) who underwent pelvic surgery and controls (n = 198) with no endometriosis in a Korean population. INTERVENTION(S):Peripheral blood samples were collected by venipuncture. MAIN OUTCOME MEASURE(S):Frequencies of genotypes and haplotypes were compared with the risk of endometriosis including -1562C>T, R279Q, P574R, and R668Q polymorphisms of MMP-9. RESULT(S):In the two-locus haplotype analyses using the four single nucleotide polymorphisms (SNPs), an increase in the distribution of the R279Q/P574R (2678G>A/4859C>G) (AC haplotype: odds ratio [OR] = 3.180, 95% confidence interval [CI] = 1.956-5.170; GG haplotype: OR = 4.374, 95% CI = 2.376-8.053) and -1562C>T/R668Q (-1562C>T/5546G>A) (CA haplotype: OR = 3.280, 95% CI = 1.406-7.653) haplotypes was significantly associated with endometriosis. By contrast, the risk of endometriosis was not associated with the individual SNPs studied. CONCLUSION(S):These findings suggest that haplotype analysis was more informative than SNP analysis. The haplotypes in the MMP-9 gene may correlate with the progression of endometriosis, and further study of these variations might improve our understanding of the pathogenesis of endometriosis.

목적: 자간전증의 발병기전에 관여할 것으로 예측되는 PPARγ와 MTHFR 유전자의 단일염기다형성 및 일배체형과 한국인에서 자간전증의 연관성을 분석하고자 하였다. 연구 방법: 자간전증 환자 226명과 대조군 235명을 대상으로 하여 말초혈액검체에서 DNA를 추출하였고, PPARγ(-796A>G, P12A (C>G), H447H (161C>T)), MTHFR (A222V (677C>T), E429A (1298A>C), R594Q (1793G>A)) 유전자의 단일염기다형성의 유전자형은 SNaPShot assay kit를 이용한 single base primer extension assay로 분석하였다. 결과는 Student`s t-test, 카이제곱검정, 선형회귀분석으로 분석하였고, 일배체형 분석은 Haploview 3.2 version을 이용하여 수행하였다. 결과: 대상 환자들에서 PPARγ, MTHFR 유전자의 대립유전자 빈도 및 유전자형 빈도는 환자군과 대조군 간에 유의한 차이가 없었고 (p>0.05), PPARγ와 MTHFR의 단일염기다형성들의 유전자형은 자간전증 위험에 있어 유의한 차이가 없었다(p>0.05). PPARγ과 MTHFR 유전자의 단일염기다형성들 중 MTHFR 유전자의 3가지 단일염기다형성 677C>T, 1298A>C, 1793G>A 사이에 서로 강한 연관불균형을 보였으나 (Lod score>2.0), MTHFR 유전자의 TAG, CAG, CCA, CCG 일배체형의 유전자형의 분포는 환자군과 대조군 간에 유의한 차이가 없었고 (p>0.05) 자간전증 위험에 있어 통계적으로 유의한 차이가 없었다 (p>0.05). 결론: 이상의 결과를 통해 한국인에서 PPARγ과 MTHFR의 유전자다형성은 자간전증과 연관성이 없었고 이들의 일배체형도 연관성이 없었다.

목적: VBAC 성공률을 높이고, 무리한 시도분만에 따른 합병증을 줄이기 위하여 VBAC 성공인자에 대한 연구와 더불어, VBAC 성공군과 실패군에서의 산과적 및 신생아 합병증을 살펴보고, VBAC 군과 미분만부 및 다분만부 간의 분만 진행시간 비교를 통하여 VBAC의 난산 기준 설정 및 안전성에 대한 평가 기준을 확립하고자 하였다. 연구 방법: 98예의 VBAC 시도분만 중 자연분만에 성공한 61예를 성공군으로 설정하였고, 자연분만에 실패한 37예를 실패군으로 설정하였다. 분만 진행시간 대조군으로는 단태아, 두위임신이면서 만삭 질식분만을 한 미분만부와 두 번째 질식분만을 한 다분만부 중 각각 100명을 무작위 추출하여 비교군으로 설정하였으며, 의무기록 및 분만 기록지를 검토하여 후향적 연구를 시행하였다. 결과: 분만력, 선행 제왕절개 횟수, 재태 연령, 초음파로 예측한 태아 몸무게, 신생아 몸무게, 입원 당시의 자궁경부 소실과 개대 정도, Bishop score, 자연 진통 유무 및 프로스타글란딘 혹은 옥시토신의 사용 유무가 VBAC 성공 예측에 의미 있는 인자로 나타났다. 그 중 초음파로 예측한 태아 몸무게와 자궁경부 소실정도 및 옥시토신을 사용하여 진통 증강을 시킨 경우가 VBAC의 성공과 실패에 가장 관련된 인자로 나타났다. VBAC 성공군의 분만진행 시간은 분만 1기 활성기 및 분만 2기 모두 미분만부군보다 통계학적으로 유의하게 짧은 반면, 두 번째 다분만부보다는 유의하게 길었다. 결론: VBAC의 성공인자 및 분만 진행의 특성을 바탕으로 VBAC의 기준안을 만들고 이에 따라 VBAC을 실시한다면 불필요한 반복 제왕절개술을 줄이게 되어 임산부 개인 및 사회 경제적으로도 이익을 주는 데 큰 역할을 할 것으로 기대된다.

Apert Syndrome is a kind of developmental disorder characterized by the craniosynostosis by synostosis of the coronal suture, bilateral symmetric syndactyly of the limbs (mitten-like hands and feet), midfacial hypoplasia, and variable degree of mental retardation. In 1894, Wheaton did the first description, and in 1906, it was named by Apert. Apert Syndrome is a rare autosomal dominent disorder and the prevalance at birth is estimated from 1:100000 to 160000. This syndrome is developed by the result of a mutation in the fibroblast growth factor receptor 2 gene (FGFR 2) located at 10q25.3-26. In familial cases, diagnosis in the first trimester sometimes has been made. But In sporadic cases, mostly it has been diagnosed in the second or third trimester by ultrasonography. In Korea, Apert syndrome is so rare, and it has not yet been reported that Apert syndrome is defined by prenatal molecular diagnosis with ultrasonographic detection. We present a case of prenatal molecular definitive diagnosis of Apert syndrome suspected strongly by ultrasonographic finding with a brief review of literature. Mother of affected fetus was transferred to our hospital at weeks’ gestation due to abnormal fetal ultrasound finding of severe polyhydroamnios and bilateral syndactyly of hands detected at weeks’ gestation. We suspected Apert syndrome by fetal ultrasonographic finding, and then confirmed Apert syndrome by DNA analysis of fetal amniocyte from therapeutic amnioredution at weeks’ gestation.

Pulmonary sequestration is development mass of nonfunctioning bronchopulmonary tissue that is separate from the normal tracheobroncheal tree and receives arterial blood from the systemic circulation. Pulmonary sequestration has an excellent prognosis and frequently can be seen to regress spontaneously on serial prenatal sonogram. But in cases with hydrops the prognosis is poor and associated with a high rate of perinatal mortality and severe respiratory insufficiency in the newborn. We report the case of a fetus presenting at 31 weeks with generalized hydrops, bilateral hydrothorax and a left pulmonary hyperechogenic mass, successfully treated by thoracoamniotic shunting using a catheter and amniodrainage. Serial ultrasound showed normal growth and normal amniotic fluid volume. The newborn did not require surgery and long-term outcome was normal. Based on this observation, the natural history of pulmonary sequestration and prenatal management options are reviewed and discussed.

Objective : This study was aimed to investigate the vascular endothelial growth factor (VEGF) mRNA and angiopoietin (Ang) -1 & -2 mRNA expressions between cervical cancer and normal cervix, and to assess the relationships among their expression and other prognostic factors of invasive cervical cancer. Methods : The tissues were obtained from 34 patients with cervical cancer and 14 patients with normal cervix undergoing hysterectomy. Total RNA was extracted and reverse transcribed into cDNA. RT-PCR and QC-PCR was performed to evaluate VEGF and Ang-1 & -2 mRNA expressions. Clinicopathologic factors of cervical cancer were reviewed with the patient's charts and results were analyzed with Mann-Whitney U test, Spearman correlation test and logistic regression analysis. Results : VEGF, Ang-1 & -2 mRNA expression in cervical cancer was higher than that in normal cervix (p

Adenoid cystic carcinoma of the Bartholin's gland is a rare malignant tumor comprising less than 1% of all female genital tract tumors. Because of low incidence, knowledge of management and factors influencing the clinical outcome of patients is limited and there is no consensus regarding the most optimal treatment. We report a case of 73-year-old woman with adenoid cystic carcinoma of the Bartholin's gland.

Multiple primary malignant neoplasm means that more than 2 cancers are independently developed in one individual. In general, the neoplasms are diagnosed simultaneously or within 6 month interval. Simultaneous presentation of carcinomas involving ovary and uterus is not a common event and presents a diagnostic dilemma when they are of the same histology. We experienced a rare case of multiple primary malignant neoplasm involving the uterine endometrium and the ovary synchronously. Thus we report this case with a review of literatures.

Objective : Enzymes belonging to the Glutathione S transferase and cytochrome P450 families are involved in the two-stage detoxification process of a number of pro-carcinogens. We genotyped each 74 women with moderate or severe endometriosis and a control group of 93 women with a normal pelvis at cesarian section to investigate whether genetic polymorphism of CYP1A1, GSTT1, and GSTM1 are associated with endometriosis. Materials and Methods : We investigate 74 women who were operated for endometriosis and 93 women who had no endometriotic lesion proved by operation. Polymerase chain reaction (PCR) and restriction fragment length polymorphism of PCR was done to determine each participant's genotype. Results : We have found no significant differences between cases and controls in the frequencies of the GSTM1 and GSTT1 null mutations, or of the CYP1A1 MspI polymorphism does not differ significantly between groups. When GSTT1 and GSTM1 null mutation was combined with CYP1A1 MspI polymorphism, there was no significant differences between groups, either. Conclusion : Therefore, These low penetrance genes are not associated with increased susceptibility to endometriosis. Further studies are warranted to identify major susceptibility gene (s) and the mechanism involved in endometriosis to assist in the development of better methods for early detection, diagnosis and prevention.

Objective : To evaluate the ability of preoperative serum CA-125 level to predict the outcome of primary cytoreductive surgery in patients with epithelial ovarian carcinoma. Methods : We performed a retrospective chart review of 85 consecutive patients with epithelial ovarian carcinoma. All patients had preoperative serum CA-125 levels measured. We used a receiver operating characteristics curve (ROC) to determine the CA-125 level with the maximal power in predicting the outcome of primary cytoreductive surgery. Results : The median CA-125 level was 890.9 U/mL for all patients. Preoperative CA-125 level had significant correlations with histology, tumor grade, stage, and the presence of ascites (p<0.05). Also, preoperative CA-125 level showed significant difference between patients with suboptimal cytoreduction and those with optimal cytoreduction (2584.9 U/mL vs. 524.8 U/mL, p<0.05). Using the ROC, we found that preoperative CA-125 level of 1050 U/mL had the most powerful ability in predicting the outcome of primary cytoreductive surgery, but a poor negative predictive value (sensitivity 66.7%, specificity 64.0%, PPV 81.6%, NPV 44.4%). Optimal cytoreductive surgery was achieved in 81.6% (40/49) among patients with CA-125 <1050 U/mL, but 55.6% (20/36) among those with CA-125=1050 U/mL (p<0.05). Conclusion : We think that preoperative CA-125 level may be used for selection of candidates for neoadjuvant chemotherapy before primary cytoreductive surgery. But preoperative CA-125 level was a weak negative predictor of primary optimal cytoreductive surgery. Thus, preoperative CA-125 level could not be a primary predictor of the outcome of primary cytoreductive surgery and should be considered in the context of other preoperative features.

목적 : 분만 당시 혈중 호모시스테인의 증가가 자간전증의 발병과 연관성이 있는지를 살펴 보고 MTHFR 유전자의 변이, 혈중 엽산 및 혈중 비타민 B12의 수치가 한국인 임신부의 자간전증의 발병에 위험요인으로서 작용하는지를 알아보고자 하였다. 연구 방법 : 2000년 3월부터 2002년 1월까지 이화여자대학교 부속 목동병원 산부인과를 방문하여 분만한 191명의 정상 임신부와 84명의 자간전증을 보인 임산부를 대상으로 하여 공복시 채취한 혈액에서 DNA를