OBJECTIVE: To assess the difference of baseline hormonal status and pathophysiology, and confirm the risk factors for long term complication according to Body Mass Index in women with polycystic ovary syndrome. MATERIALS AND METHODS: Serum level of LH, FSH, Estradiol, Prolactin, Testosterone, DHEA-S, fasting insulin were measured and 100 gm oral glucose tolerance test and endometrial biopsy were performed in total 75 chronic anovulation patients and 20 normal cycling infertility patients. 95 evaluated patients were divided into 3 groups including patients with chronic anovulation having BMI below 25, BMI beyond 25.1, normal cycling infertility patients, Group 1 (n=39), Group 2 (n=36), Group 3 (n=20), respectively. Statistical analysis was performed respect to relationship between BMI and measured hormone level, sum of glucose level during 100 gm OGTT, insulin resistance using t-test, ANOVA test, Post Hoc test, Mann-Whitney test. p<0.05 was considered as statistically significant. RESULTS: Serum LH level and LH/FSH ratio was significantly higher in Group 1, compared than Group 2 or 3 (p<0.05), BMI and LH, LH/FSH ratio was negatively correlated (r=-0.351, r=-0.318). There was no significant difference according to BMI in FSH, testosterone, estradiol, prolactin, DHEA-S level. Fasting insulin and sum of glucose level during 100 gm OGTT were significantly higher in Group 2 compared than Group 1 or Group 3 (p<0.05), there was no significant difference between Group 1 and Group 3. Insulin resistance was more frequently identified in Group 2 compared than Group 1 (p=0.001). CONCLUSIONS: BMI and LH, LH/FSH ratio were negatively correlated, so clinical significance of LH, LH/FSH ratio in diagnosis of PCOS may be attenuated by increasing body weight. Overweight patients with chronic anovulation may be the risk group for developing insulin resistance, hyperinsulinemia, glucose intolerance, later type 2 DM. Hyperinsulinemia may operate mainly in overweight chronic anovulation patients in development of hyperandrogenism.
Anovulation* ; Biopsy ; Body Mass Index* ; Body Weight ; Diagnosis ; Estradiol ; Fasting ; Female ; Glucose Intolerance ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Infertility ; Insulin ; Insulin Resistance ; Metabolism* ; Overweight ; Polycystic Ovary Syndrome ; Prolactin ; Risk Factors ; Testosterone

OBJECTIVES: To evaluate the relation between diagnostic clinical parameters and the depth of trophoblastic invasion in tubal pregnancy and decide the most predictable parameter. Methods: Total 50 patients who were confirmed as tubal pregnancy pathologically, from Jan. to Dec. 1997, were included in this study. Menstrual missed periods was calculated by clinical history, volume of gestational mass was calculated as sphere, beta-hCG was titered with preoperative blood sample. All surgical specimens were examined pathologically and divided into two groups such as intraluminal and extraluminal, defined as intact tubal musculature and trophoblastic invasion beyond musculature, n=22 and n=28, respectively. Statistical analysis was performed among three parameters and between each parameter and the depth of trophoblastic invasion. Statistical analysis included were Student's t-test, Chi square, linear regression, and linear correlation analysis using SPSS statistical package and statistical significance was determined as p<0.05. RESULTS: There was a correlation between volume of gestational mass and beta-hCG(p<0.05), but not between beta-hCG and missed period or volume of gestational mass and missed period. beta-hCG level was 1843.7+/-1524.7 mIU/ml(Mean+/-SD) in intraluminal and 12144.3+/-10561.6 mIU/ml(Mean+/-SD) in extraluminal. There was a predictive correlation between beta-hCG and the depth of trophoblastic invasion(p<0.05), and cut off level 3,500 mIU/ml showed the highest sensitivity, specificity, positive predictive value, negative predictive value, 0.79, 0.86, 0.88, 0.76, respectively. Two parameters(volume of gestational mass and missed period) had no ability to predict whether intraluminal or extraluminal. CONCLUSION: We suggest that successful medical treatment of tubal pregnancy depend on lesional intactness of vasculature for drug delivery. In patient selection for medical treatment, it should be important to predict intraluminal type because of intact vasculature. Of clinical parameters, beta-hCG is single most predictive parameter, cut off level of 3,500 mIU/ml was the most reasonable level in this study.
Female ; Humans ; Linear Models ; Patient Selection ; Pregnancy ; Pregnancy, Tubal* ; Sensitivity and Specificity ; Trophoblasts*

OBJECTIVE: To assess the association with autoimmune endocrine diseases and detection rate of autoimmune antibodies and its clinical significance in patients with premature ovarian failure. METHODS: Twenty eight patients with primary or secondary amenorrhea manifesting hormonal and clinical features of premature ovarian failure (primary POF: 7, secondary POF: 21) were investigated. We tested them TFT, 75 g OGTT, ACTH and S-cortisol for thyroiditis, IDDM, Addison's disease, and antithyoglobulin antibody, antimicrosomal antibody, antinuclear antibody, rheumatic factor, anti-smooth muscle antibody, anti-acetylcholine receptor antibody for non-organ specific autoimmune disorders. RESULTS: Only one patient was diagnosed as IDDM and no patients had abnormal TFT or adrenal function test. More than one kind of autoantibody was detected in 11 patients of all (39.2%): 5 patients (71.4%) of primary POF group and 6 patients (21.4%) of secondary POF group. Eleven patients (39.3%) had antithyroglobulin antibody, 4 (14.3%) had antimicrosomal antibody, 2 (7.1%) had antinuclear antibody, 2 (7.1%) had rheumatic factor, 1 (3.6%) had anti-smooth muscle antibody, 1 (3.6%) had anti-acetylcholine receptor antibody. CONCLUSIONS: Premature ovarian failure may occur as a component of an autoimmune polyglandular syndrome, so patients should be measured with free thyroxine, thyroid-stimulating hormone, fasting glucose and electrolytes. Measurement of thyroid autoantibodies in POF patients may be important in identifying patients at risk of developing overt hypothyoidism, but other autoantibodies may not be suitable for screening test.
Addison Disease ; Adrenocorticotropic Hormone ; Amenorrhea ; Antibodies ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases* ; Diabetes Mellitus, Type 1 ; Electrolytes ; Endocrine System Diseases ; Fasting ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Mass Screening ; Primary Ovarian Insufficiency* ; Thyroid Gland ; Thyroiditis ; Thyrotropin ; Thyroxine

No abstract available.
Embryonic Structures* ; Female ; Fertilization in Vitro* ; Pregnancy ; Pregnancy, Tubal*

No abstract available.
Humans ; Pregnancy, Twin*

Androgen insensitivity syndrome is a genetic syndrome characterized by complete or partial resistance of end organ to the peripheral effect of androgen. Patient have a male karyotype(46,XY) and bilateral testes. Appearance of external genitalia depend on the degree of androgen insensitivity. In the complete form, external genitalia is normal female but in the incomplete form, external genitalia figure varies hom that of a virilized female to that of an undervirilized male with a short penis and hypospadia. The gonads are able to be located along the descending course of the testis during development. The usual presenting symptom in complete type is primary amenorrhea or inguinal mass, but in incomplete type, the patient mainly present with ambiguous genitalia. Recently we experienced one case of this syndmme and removed the bilateral gonads, so we report it with brief review of literatures.
Amenorrhea ; Androgen-Insensitivity Syndrome* ; Disorders of Sex Development ; Female ; Genitalia ; Gonads* ; Humans ; Hypospadias ; Male ; Penis ; Testis

46, XX male is a rare sex cluomasomal constitution characterized by the development of bilateral testis in persons who lack a Y chomosome. The majority of affected persons have normal external genitalia and usually seek medical advice due to infertility, hypogonadism and/or gynecomastia in adulthood. Although Y chromosomsl sequences can be detected in the majority of male subjects with 46, XX karyotype, several studies have shown thst approximately 10 % of patients lack Y chromosomal material including the SRY ( sex-determining region of Y-chromosome) gene. Several hypothesis have been proposed to explain the etiology of this constitution. 1. Translocation of the testis-determining factor (TDF) fiom the Y to the X chromosome or autosome. 2. Acquisition of Y chromosome function by a mutant autosomal or X-linked gene. 3. Undetected mosaicism with Y-bearing cell line 4. Loss of Y chmmosome hom the XXY Klinefelter zygote. We experienced a case of 46, XX male who was 30 years old. We report a case with review of the literature.
Adult ; Cell Line ; Constitution and Bylaws ; Genes, X-Linked ; Genitalia ; Gynecomastia ; Humans ; Hypogonadism ; Infertility ; Karyotype ; Male* ; Mosaicism ; Sex-Determining Region Y Protein ; Testis ; X Chromosome ; Y Chromosome ; Zygote

Hepatoid carcinoma is a rare type of malignant tumor resembling hepatocellular carcinoma that arises in extrahepatic sites.(stomach, lung, ovary, pancreas, bladder and renal pelvis). Hepatoid carcinoma of the ovary is an extremely rare ovarian tumor, first described by Ishikura and Scully in 1987. Histologically it is important to differentiate this entity from other oxyphil tumors of the ovary as it requires aggressive treatment. We have experienced a case of hepatoid carcinoma of the ovary in 69-year-old postmenopausal woman, who has been treated with operation and adjuvant Taxol - cisplatin chemotherapy. We present this case with brief review of literatures.
Aged ; Carcinoma, Hepatocellular ; Cisplatin ; Drug Therapy ; Female ; Humans ; Lung ; Ovary ; Paclitaxel ; Pancreas ; Pregnancy* ; Primary Ovarian Insufficiency* ; Urinary Bladder

Recent advances in assisted reproductive technology have been able to overcome the nearly all problems associated with traditional infertility factor. IVF and ET using donated oocyte has brought new hope to many couples who otherwise would remain childless, so oocyte donation can be the alternative treatment modality for specific fatal infertility patients. The high success rate of this procedure has led to its wide application in women with ovarian failure or dysfunction, at various ages and for various etiologies. Oocyte donation is also offered to patients who repeatedly fail to conceive with standard IVF. But there are many conflicting issues in this procedure such as moral, ethical, medical, legal problems. We review the technical aspects related with oocyte donation in infertility treatment and ethico-legal issue.
Family Characteristics ; Female ; Hope ; Humans ; Infertility* ; Oocyte Donation* ; Oocytes* ; Reproductive Techniques, Assisted

OBJECTIVE: To assess the etiologic diagnosis of primary amenorrhea and review the clinical significance in management of primary amenorrhea. METHODS: To make the accurate etiologic diagnosis of primary amenorrhea, karyotype, hormone study (TSH, Prolactin, LH, FSH, Estradiol, Testosterone, DHEA-S), various imaging techniques were performed in total 57 patients. And additional GnRH stimulation test and bone densitometry were also performed in group of hypogonadotropic amenorrhea with normal sella and brain imaging for discriminating the hypothalamic and pituitary cause and in patients with low estrogenic state for identifying the risk of osteoporosis, respectively, then reviewed as to clinical significance according to etiologic classification, karyotypical abnormalities, and risk of osteoporosis in low estrogenic group. RESULTS: The range of age at diagnosis was from 13 to 34 years, most commonly, 17-18 years, 26.3%. The most common causes of primary amenorrhea was 46,XX ovarian failure and hypothalamic failure, 19.3% and 19.3%, respectively. The next common causes were genetic disorder related with Turner syndrome (17.5%), M llerian agenesis (12.3%), complete androgen insensitivity syndrome (10.5%), orderly. In cytogenetic study, 19 patients (34%) showed abnormal karyotype, of abnormal karyotypes, Turner genotype was most common (52%), and 46,XY was second most common (31.5%). Almost all patients with low estrogenic state showed osteopenia or osteoporosis. CONCLUSION: The most common causes of primary amenorrhea were 46,XX gonadal failure, hypothalamic failure, Turner syndrome. These all patients were at high risk of osteoporosis or osteopenia.
Abnormal Karyotype ; Amenorrhea* ; Androgen-Insensitivity Syndrome ; Bone Diseases, Metabolic ; Classification ; Cytogenetics ; Densitometry ; Diagnosis ; Estradiol ; Estrogens ; Female ; Genotype ; Gonadotropin-Releasing Hormone ; Gonads ; Humans ; Karyotype ; Male ; Neuroimaging ; Osteoporosis ; Prolactin ; Testosterone ; Turner Syndrome