1.Disseminated intravascular coagulation developed after controlled ovarian hyperstimulation in woman with adenomyosis.
Jong Kil JOO ; Dyeok Hyeon JO ; Yun Ji BAEK ; Jong Ryeol CHOI ; Kyu Sup LEE
Korean Journal of Obstetrics and Gynecology 2009;52(11):1174-1179
Disseminated intravascular coagulation (DIC) is usually developed after infection, metastatic cancer or complicated pregnancy. We experienced a case of infertile woman with adenomyosis, who had not been predisposed any common risk factors but had acute DIC during menstruation after controlled ovarian stimulation. The patient received anticoagulation therapy with supplementation of coagulation factors, followed by surgical removal of uterus 3 months later. We assumed that DIC resulted from rapidly aggravated lesion during controlled ovarian stimulation and massive intramuscular hemorrhage during menstruation. So, we report the case with brief review of literatures.
Adenomyosis
;
Blood Coagulation Factors
;
Dacarbazine
;
Disseminated Intravascular Coagulation
;
Female
;
Hemorrhage
;
Humans
;
Infertility
;
Menstruation
;
Ovulation Induction
;
Pregnancy
;
Risk Factors
;
Uterus
2.Clinical outcomes of three- or five-day treatment with clomiphene citrate combined with gonadotropins and a timed intercourse cycle in polycystic ovary syndrome patients.
Sung Ah BAE ; Jong Kil JOO ; Jong Ryeol CHOI ; Sun Suk KIM ; Kyu Sup LEE
Clinical and Experimental Reproductive Medicine 2015;42(3):106-110
OBJECTIVE: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. METHODS: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. RESULTS: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (9.4+/-2.1 mm vs. 8.5+/-1.7 mm, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). CONCLUSION: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.
Chorionic Gonadotropin
;
Clomiphene*
;
Endometrium
;
Female
;
Gonadotropins*
;
Humans
;
Ovulation Induction
;
Polycystic Ovary Syndrome*
;
Pregnancy
;
Pregnancy Rate
3.Effect of Height and Arm Length on Simple Reaction Time.
Hyang Sook KIM ; Chae Yong LEE ; Jong Young LEE ; Mun Suk JYUNG ; Hyeong Ryeol YOON ; Gwang Seo CHOI
Korean Journal of Occupational and Environmental Medicine 1996;8(1):97-104
To identify the relation between simple reaction time and height and arm length, simple reaction time was performed to medical students with measurement of height, and arm length. Participants should answer questions about Smoking, drinking, sleep deprivation, history of diseaseand drug, whether to use computer or hot Mean height of men(n=98) was 173.0+/-4.79 cm, that of women (n-22) 161.7+/-4.33 cm. Mean arm length of men was 73.5+/-3.09 cm, and that of women 68.0+/-2.93 cm respectively. Height and arm length were statistically significantly different between-men and women (plt;0.01). Mean simple reaction time of men was 265.4+/-25.03 msec, that of women 286.8+/-28.48 msec. Mean simple reaction time was also statistically significantly different(p<0.01). As a result of correlation analysis, for men. None was significant. However, for women, height and arm length showed statistically significant, correlation with mean reaction time. Correlation coefficient of height and arm length were 0.45 (p<0.05) and 10.57 (p<0.05) respectively.
Arm*
;
Drinking
;
Female
;
Humans
;
Male
;
Reaction Time*
;
Sleep Deprivation
;
Smoke
;
Smoking
;
Students, Medical
4.Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 as prognostic factors in endometrial cancer.
Jong Ryeol CHOI ; Tae Hwa LEE ; Young Lim OH ; Chun Jun LEE ; Won Gyu KIM
Korean Journal of Gynecologic Oncology 2008;19(1):57-67
OBJECTIVE: Homeostasis of the extracellular matrix (ECM) is maintained by the action of a specific system of proteolytic enzymes known as matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP). The MMP/TIMP system regulates the composition and turnover of ECM to control the site and extent of connective tissue remodeling. In pathologic conditions, MMP play a key role in degradation of basement membrane and extracellular matrix, and is responsible for cancer invasion, progression and metastasis. The aim of this study is to evaluate the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. METHODS: Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 were assessed by immunohistochemistry in a total of 55 endometrial cancers and were analyzed by the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. RESULTS: Expression rates of MMP-2,-9, TIMP-1, and TIMP-2 were 71.7%, 54.9%, 41.2%, and 76.5% respectively. Expression of MMP-2 was correlated with the group of positive lymph node metastasis in endometrial cancer (p=0.04). Specially, coexpression of MMP-2 and TIMP-2 was significantly more frequent in the group of positive lymph node metastasis (p<0.01) and the group of positive peritoneal CONCLUSION: The expressions of MMP and TIMP were not a significant difference in survival analysis, but this study was recognized that the coexpression MMP-2 and TIMP-2 is correlated with lymph node metastasis and positive peritoneal cytology.
Basement Membrane
;
Connective Tissue
;
Endometrial Neoplasms
;
Extracellular Matrix
;
Female
;
Homeostasis
;
Immunohistochemistry
;
Lymph Nodes
;
Matrix Metalloproteinases
;
Metalloproteases
;
Neoplasm Metastasis
;
Peptide Hydrolases
;
Tissue Inhibitor of Metalloproteinase-1
;
Tissue Inhibitor of Metalloproteinase-2
5.Hepatic Arterial Infusion Chemotherapy Using the Port System in Advanced Gallbladder Cancer
Jong Ryeol EUN ; Jae Woon KIM ; Joon Hyuk CHOI
Korean Journal of Medicine 2018;93(1):50-54
Gallbladder (GB) cancer is relatively rare and has a poor prognosis, with a median survival time of less than 3 months. It is resistant to chemotherapy. Therefore, the role of systemic chemotherapy is limited. However, administering the anticancer agent directly into the hepatic artery can result in a higher drug concentration in the cancer tissue. In this paper, we report a case of advanced GB cancer treated with hepatic arterial infusion chemotherapy (HAIC) using the port system. The patient received six cycles of HAIC with 5-fluorouracil (750 mg/m²) and cisplatin (25 mg/m²); each cycle lasted for 4 days every month. The tumor showed objective response during HAIC, and the patient survived for 15 months from the first therapy. HAIC using the port system might be a promising therapeutic modality for treating locally advanced GB cancer.
Cisplatin
;
Drug Therapy
;
Fluorouracil
;
Gallbladder Neoplasms
;
Gallbladder
;
Hepatic Artery
;
Humans
;
Prognosis
6.Hepatic Arterial Infusion Chemotherapy Using the Port System in Advanced Gallbladder Cancer
Jong Ryeol EUN ; Jae Woon KIM ; Joon Hyuk CHOI
Korean Journal of Medicine 2018;93(1):50-54
Gallbladder (GB) cancer is relatively rare and has a poor prognosis, with a median survival time of less than 3 months. It is resistant to chemotherapy. Therefore, the role of systemic chemotherapy is limited. However, administering the anticancer agent directly into the hepatic artery can result in a higher drug concentration in the cancer tissue. In this paper, we report a case of advanced GB cancer treated with hepatic arterial infusion chemotherapy (HAIC) using the port system. The patient received six cycles of HAIC with 5-fluorouracil (750 mg/m²) and cisplatin (25 mg/m²); each cycle lasted for 4 days every month. The tumor showed objective response during HAIC, and the patient survived for 15 months from the first therapy. HAIC using the port system might be a promising therapeutic modality for treating locally advanced GB cancer.
7.Effectiveness of Flumazenil against Midazolam as Premedication for Upper Gastrointestinal Endoscopy.
Uk Don YUN ; Seok Ryeol CHOI ; Jong Hun LEE ; Dae Hyun CHOI ; Jong Min SHIN ; Myung Hwan RHO ; Sang Young HAN ; Woo Won SHIN
Korean Journal of Gastrointestinal Endoscopy 2000;21(1):518-524
BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma
;
Consciousness
;
Diazepam
;
Endoscopy
;
Endoscopy, Gastrointestinal*
;
Flumazenil*
;
Humans
;
Midazolam*
;
Premedication*
;
Vital Signs
8.The hyperexpressions of putative stem cells in the eutopic endometrium of patients with advanced endometriosis.
Jong Ryeol CHOI ; Jong Kil JOO ; Yong Jin NA ; Kyung Rae KO ; Hong Gu LEE ; Kyu Sup LEE ; Yong Taek LIM
Korean Journal of Obstetrics and Gynecology 2010;53(3):264-273
OBJECTIVE: Recently it has been proposed that stem cells may be associated with the pathogenesis of endometriosis. The purposes of this study are to investigate whether the eutopic endometrial cells of women with or without endometriosis show the characteristics of stem cells in vitro and have a difference of the expressions of the undifferentiated stem cell markers as OCT-4 and CXCR4. METHODS: A total of 6 women with advanced endometriosis and a total of 10 women without endometriosis, adenomyosis or leiomyoma were included in this study. The eutopic endometrial cells, which were obtained from the menstrual blood at menstrual cycle day 2 to 4, were cultured in vitro for approximately 2 weeks, subsequently the putative very small stem cells were separated by Percoll density gradient method and were cultured. The expressions of OCT-4 and CXCR4 were analyzed by real time RT-PCR. RESULTS: The eutopic endometrial cells of the group of endometriosis compared with the control group showed the different morphological characteristics in vitro; more commonly heterogeneous supportive cells, very small round cells less than 3 micrometer and 5~15 micrometer sized hyperchromatic round cells. After the separation of very small round cells by Percoll density gradient method, these cells showed the several characteristics of stem cells; self-renewal, asymmetric cell division, colony formation and embryoid body-like formation. Also These cells showed the similar characteristics of very small embryonic-like stem cells; the mobile cells smaller than erythrocyte, the cell migration or adhesion to supportive cells, the sphere formation by cell aggregation and the formation of new differentiated cell by cell fusion. The expressions of OCT-4 and CXCR4 in the group of endometriosis are respectively 5.66 times and 17.69 times as high as the control group (P<0.05). CONCLUSION: The very small round cells less than 3 micrometer and 5~15 micrometer sized hyperchromatic round cells, which showed the several characteristics of stem cells in vitro, were more common in eutopic endometrial cells of patients with endometriosis and the expressions of OCT-4 and CXCR4 were significantly higher. This study suggests that stem cells might play a key role in the pathogenesis of endometriosis and OCT-4 and CXCR4 might be used as a tool for diagnosis or follow-up.
Adenomyosis
;
Asymmetric Cell Division
;
Cell Aggregation
;
Cell Fusion
;
Cell Movement
;
Endometriosis
;
Endometrium
;
Erythrocytes
;
Female
;
Humans
;
Leiomyoma
;
Menstrual Cycle
;
Povidone
;
Silicon Dioxide
;
Stem Cells
9.Effect of the decidualization of human endometrial cells on the hatching rates of the vitrified and the fresh mouse blastocysts.
Sheng Ta SUN ; Gyoung Rae KO ; Ji Hye JUNG ; Jong Ryeol CHOI ; Jong Kil JOO ; Kyu Sup LEE
Korean Journal of Obstetrics and Gynecology 2009;52(3):336-345
OBJECTIVE: To compare the hatching rates of the vitrified and the fresh mouse blastocysts co-cultured with decidualized or non decdualized human endometrial cells and to confirm the necessity of assisted hatching in the vitrified mouse blastocyst. METHODS: Stromal and epitherial cells isolated from human endometrial tissue were co-cultured and decidualized with TGF-beta 1 and progesterone. The vitrified and the fresh mouse blastocysts were co-cultured with human decidualized or non-decidualized endometrial cells, respectively and the hatching rates were investigated. RESULTS: Epithelial and stromal cells isolated from endometrial tissue were cultured seperately for 24 hours and stained by immunohistochemical staining for cytokeratin (epithelial cells) or vimentin (stromal cells). The immunohistochemical study was positive for cytokeratin or vimentin and confirmed that epithelial and stromal cells were isolated from endometrial tissue successfully. The co-cultured human stromal and epitherial cells were decidualized by administration of TGF-beta 1 and progesterone. The hatching rates of the fresh and the vitrified mouse blastocysts co-cultured with decidualized human endometrial cells were 89% and 31%, respectively. The hatching rates of the fresh and the vitrified mouse blastocysts co-cultured with non-decidualized human endometrial cells were 82% and 27%, respectively. The hatching rates were significantly higher in fresh mouse blastocysts than in vitrified mouse blastocysts regardless of decidualization of human endometrial cells (P<0.05). CONCLUSION: The hatching rate was significantly higher in fresh mouse blastocysts than in vitrified mouse blastocysts. This results showed that the cryopreservation procedure caused the zona hardening of mouse blastocyst and the decidualization of endometrial cells did not affect to hatching rate of the vitrified mouse blastocysts. We confirmed that assisted hatching was necessary for improving the hatching rate of cryopreserved mouse blastocysts.
Animals
;
Blastocyst
;
Coculture Techniques
;
Cryopreservation
;
Herpes Zoster
;
Humans
;
Keratins
;
Mice
;
Progesterone
;
Stromal Cells
;
Transforming Growth Factor beta
;
Vimentin
10.Preliminary clinical outcome of novel strategy for the maximization of cumulative pregnancy rates per retrieval in normal responders.
Jong Kil JOO ; Jong Ryeol CHOI ; Jung Bin SON ; Gyoung Rae KO ; Kyu Sup LEE
Clinical and Experimental Reproductive Medicine 2012;39(1):33-39
OBJECTIVE: We devised a novel strategy, a GnRH antagonist protocol with a GnRH agonist trigger followed by frozen-thawed blastocyst transfers with long zona dissection (LZD). The purpose of this study was to investigate the clinical outcomes of this new strategy according to age. METHODS: Ninety women aged less than 35 (group A) and 32 women aged 35 to 39 (group B) underwent the GnRH antagonist protocol with a GnRH agonist trigger in order to obtain many oocytes and prevent early-onset ovarian hyperstimulation syndrome (OHSS). All oocytes were cultured to the blastocyst stage and all blastocysts grade 3BB or better were cryopreserved. Embryo transfers were only performed in freeze-thaw cycles to prevent late-onset OHSS and to overcome embryo-endometrium dyssynchrony. LZD was performed just after thawing to improve hatching and implantation rates. RESULTS: The average numbers of retrieved oocytes and blastocysts grade 3BB or better were 12.8+/-5.5 and 4.4+/-2.6 in group A and 10.9+/-7.4 and 2.5+/-2.2 in group B, respectively, and OHSS did not occur in any of the women. Implantation rates were 46.7% in group A and 39.3% in group B. Cumulative clinical pregnancy rates per retrieval were 77.8% in group A and 62.5% in group B. Cumulative ongoing pregnancy rates per retrieval were 71.1% in group A and 53.1% in group B. CONCLUSION: GnRH antagonist protocol with GnRH agonist trigger followed by frozen-thawed blastocyst transfers with LZD can generate many blastocysts without OHSS and maximize cumulative pregnancy rates per retrieval. This strategy is more effective in young women aged less than 35 than in women aged 35 to 39.
Aged
;
Blastocyst
;
Embryo Transfer
;
Female
;
Gonadotropin-Releasing Hormone
;
Herpes Zoster
;
Humans
;
Oocytes
;
Ovarian Hyperstimulation Syndrome
;
Pregnancy
;
Pregnancy Rate