Systemic lupus erythematosus(SLE) is a multisystem disorder with a peak age of onset in the second and fourth decades of life predominantly occuring in females who will usually have the potential to become pregnant. This female to male predominance is greatest during childbearing years approaching a ratio of 13:1, after the menopause it declines to a ratio of 3:1, the ratio also seen in prepubertal years. In practice, despite the higher prevalence of rheumatiod arthritis, pregnancy in SLE is the most common management problem confronting physician and obstetrician amongst the connective tissue disorders and it is particularly important as the outcome of pregnancy is more unpredictable in this disease. As well as having clinical consequences for the health of both mother and fetus, pregnancy in lupus provides a model for studying the importance of other biological phenomena characterizing the disease. For example, the transplacental passage of maternal antibodies to Ro(SSA) and La(SSB) and their strong association with the neonatal lupus syndrome suggests a pathogenetic role for these autoantibodies. Other relevant issues are feto-meternal immunological tolerance and hormonal interaction with the immune system. We have experienced a case of recurrent pregnancy loss associated with systemic lupus erythematosus. So we report this case with a brief review of literatures.
Age of Onset ; Antibodies ; Arthritis ; Autoantibodies ; Biological Phenomena ; Connective Tissue ; Female ; Fetus ; Humans ; Immune System ; Lupus Erythematosus, Systemic* ; Male ; Menopause ; Mothers ; Pregnancy* ; Prevalence

Toxoplasma gondii, an intracellular coccidian protozoan, is the causative agent of toxoplasmosis, a widespread infection affecting various birds and mammals including humans. In immunocompetent hosts, the infection is usually asymptomatic and benign. Toxoplasmosis is either congenital or acquired. In general prenatal therapy of congenital toxoplasmosis is beneficial in reducing the ncy of infant infection. Therapies are based primarily on spiramycin because of the relative lack of toxicity and high concentration achieved in the placenta. Clindamycin is the standard drug for chemoprophylaxis in newborn infants, and is directed at preventing the occurrence of retinochoroiditis as a late sequel to congenital infection. The standard treatment for acquired toxoplasmosis in both immunocompetent and immunodeficient patients is the synergistic combination of pyrimethamine and sulphonamides. Toxoplasmic encephalitis is tbe most common manifestation of acquired toxoplasmosis in immunocompromised patients and if not treated is fatal. However, because of toxicity, the therapeutic efficacy of pyrimethamine sulphonamide combinations may be seriously limited in immunodeficient patients. We have experienced a case of toxoplasmosis during the workup of habitual aborter. So we report this case with a brief review of literatures.
Birds ; Chemoprevention ; Clindamycin ; Encephalitis ; Humans ; Immunocompromised Host ; Infant ; Infant, Newborn ; Mammals ; Placenta ; Pyrimethamine ; Spiramycin ; Toxoplasma ; Toxoplasmosis* ; Toxoplasmosis, Congenital

INTRODUCTION There are three factors for successful implantation. These are embryo quality, uterine receptivity, and synchronization between embryonic and endometrial development. Despite remarkable progress in investigating embryos in human IVF, there has been slow progress in exploring the implantation process. It may be due to two reasons as follow. First, it is difficult to directly investigate the mechanism of implantation in the human, because of ethical considerations. Second, there is no sensitive and widely accepted marker for assessing endometrial development. Since the finding of a novel standard for dating endometrial biopsy by Noyes et. al.,. in 1950, there have been many attempts to identify suitable markers for uterine receptivity. Those include ultrasonographic changes (Ueno et.al., 1991; Grunfeld et al.,1991), three dimensional morphological changes of the endometrium such as pinopode formation (Market or alphaf., 1987; Mantel or alphaf., 1991; Nikas et al., 1995; Psychoyos & Nikas, 1994), integrin expression (Ilesanmi et al., 1993; Lessey et.al., 1992; Lessey, 1994), and measurement of endometrial proteins (Hell, 1986;Fay & Crudzinskas, 1991). Investigations in the rat (cartel et al., 1991)and human (cartel et al., 1987; Nikas et al., 1995; Psychoyos & Nikas, 1994) suggested the presence of pinopodes as a marker for the receptive phase.4 chronological barrier in uterine receptivity could be one of the major factors limiting IVF pregnancy rates. If we were able to manage the 'implantation window' we may be able to improve implantation and pregnancy rates in the human IVF program. In 1987, Martel et al., found early appearance of pinopodes in stimulated cycles for IVF compared to natural cycles in humans (Marcel et al., 1987). This effect was found in patients stimulated with clomephene citrate/hMG/hCG. The purpose of the present study was to evaluate the endometrial development in IVF patients stimulated with either by FSH/hMG/hCG or with GnRH agonist down regulation.
Animals ; Biopsy ; Down-Regulation ; Embryonic Structures ; Endometrium ; Female ; Gonadotropin-Releasing Hormone ; Humans* ; Oocyte Retrieval* ; Oocytes* ; Pregnancy Rate ; Rats

Prenature ovarian failure is a condition causing amenarrhea, hypoestrogenism, and elevated genadotropins in women younger than 40 years. A karyotype should be performed as part of basic laboratory evaluation for all patients with premature ovarian failure and prodromal premature ovarian failure. Development of a malignancy in a dysgenetic gonad is of major concern. The presence of a fragment of the Y chromosome is thought to be a key to the oncogenic potential of these gonads. The search for the testicular determining factor(TDF) has engendered much confusion about which part of the Y chromosome plays a role in malignancy. This was initially postulated to be the H- Y antigen. More recent data, however, localize the area near the centromere of the Y Chromosome, on the long arm(Yq). Malignant potential is clearly not linked to the testicular determining factor itself(SRY). This is a critical point in clinical medicine. Feilure to display SRY or a closely related sequence does not rule out the presence of the segment of the Y chromosome postulated to be associated with the development of malignancies. We have experienced a case of premature ovarian failure with chtomosomal abnormality involving Y chromosome fragment. So we report this case with a brief review of literatures.
Centromere ; Clinical Medicine ; Female ; Gonadal Dysgenesis* ; Gonads* ; Humans ; Karyotype ; Primary Ovarian Insufficiency* ; Y Chromosome

OBJECTIVE: Recently, microdissection of tissue sections has been used increasingly for the isolation of morphologically identified homogeneous cell populations, thus overcoming the obstacle of tissue complexity for the analysis cell-specific expression of macromolecules. The aim of the present study was to establish the minimal conditions required for the RNA extraction and amplification from the cells captured by the laser captured microdissection. METHODS: Mouse ovaries were fixed and cut into serial sections (7 micrometer thickness). Oocytes were captured by laser captured microdissection (LCM) method by using PixCell IITM system. The frozen sections were fixed in 70% ethanol and stained with hematoxylin and eosin, while the paraffin sections were stained with Multiple stain. Sections were dehydrated in graded alcohols followed by xylene and air-dried for 20 min prior to LCM. All reactions were performed in ribonuclease free solutions to prevent RNA degradation. After LCM, total RNA extraction from the captured oocytes was performed using the guanidinium isothiocyanate (GITC) solution, and subsequently evaluated by reverse transcriptase -polymerase chain reaction (RT-PCR) for glyceraldehyde-3-phosphate-dehydrogenase (GAPDH). RESULTS: With the frozen sections, detection of the GAPDH mRNA expression in the number of captured 25 oocytes were not repeatable, but the expression was always detectable from 50 oocytes. With 25 oocytes, at least 27 PCR cycles were required, whereas with 50 oocytes, 21 cycles were enough to detect GAPDH expression. Amount of the primary cDNA required for RT-PCR was reduced down to at least 0.25 microl with 50 oocytes, thus the resting 19.75 microl cDNA can be used for the testing other interested gene expression. Tissue-to-slide, tissue-to-tissue forces were very high in the paraffin sections, thus the greater number of cell procurement was required than the frozen sections. CONCLUSION: We have described a method for analyzing gene expression at the RNA level with the homogeneously microdissected cells from the small amount of tissues with complexity. We found that LCM coupled with RT-PCR could detect housekeeping gene expression in 50 oocytes captured. This technique can be easily applied for the study of gene expression with the small amount of tissues.
Alcohols ; Animals ; DNA, Complementary ; Eosine Yellowish-(YS) ; Ethanol ; Female ; Frozen Sections ; Gene Expression* ; Genes, Essential ; Guanidine ; Hematoxylin ; Mice ; Microdissection* ; Oocytes* ; Ovary ; Paraffin ; Polymerase Chain Reaction ; Ribonucleases ; RNA Stability ; RNA* ; RNA, Messenger ; RNA-Directed DNA Polymerase ; Xylenes

OBJETIVE: To analyze the antithrombin III deficiency in patients with recurrent spontaneous abortion. MATERIALS AND METHOD: The blood samples were tested by chromogenic assay to evaluate the activity of antithrombin III. RESULTS: There was only one case of antithrombin III deficiency. This patient experienced one neonatal death after delivery and one FDIU (fetal death in utero). And also this patient showed a lupus anticoagulant and the prolongation of PTT. CONCLUSIONS: Women with recurrent miscarriage who have no obvious identified cause should consider hematologic screening. Antithrombin III deficiency could be a cause of recurrent spontaneous abortion. But the incidence is very rare in Korean patients.
Abortion, Habitual ; Abortion, Spontaneous* ; Antithrombin III Deficiency* ; Antithrombin III* ; Female ; Humans ; Incidence ; Lupus Coagulation Inhibitor ; Mass Screening ; Pregnancy

To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac. Crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnanices were classified correctly by disciminant analysis with G-SAC and CRL (GSAC=0.5 CRL+15. Sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1 of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation. Small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies.
Bradycardia ; Crown-Rump Length ; Female ; Fetal Growth Retardation ; Gestational Sac ; Heart Rate, Fetal ; Humans ; Mass Screening ; Menstrual Cycle ; Pregnancy ; Prognosis ; Sensitivity and Specificity ; Transducers ; Ultrasonography

OBJECTIVE: To analyze the clinical characteristics of obese infertile women. MATERIAL AND METHOD: Height, weight, body mass index, menstrual pattern, glucose, insulin, glucose / insulin ratio, dehydroepiandrosterone sulfate (DHEA-S), testosterone, free testosterone and plasminogen activator inhibitor (PAI-1) of 15 obese infertile women were tested. RESULTS: Of 15 obese infertile women, the number of diabetes mellitus, hyperinsulinemia, and insulin resistance was 2 (13%), 2 (13%), 2 (13%), respectively. The incidence of increased DHEA-S, testosterone, and free testosterone was 7 (47%), 1 (7%), 6 (40%), respectively. Notably, all patients showed increased PAI-1. CONCLUSIONS: Obesity is associated with infertility as well as many kinds of health problems. Obesity is closely related to insulin resistance and it also causes hyperandrogenism. Increased PAI-1 is one of the important causes of thrombophilia. Consequently, in the workup of obese infertile patient, many aspects of health problems should be considered.
Body Weight ; Dehydroepiandrosterone Sulfate ; Diabetes Mellitus ; Female ; Glucose ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Incidence ; Infertility ; Insulin ; Insulin Resistance ; Obesity ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Testosterone ; Thrombophilia

OBJECTIVE: To report the pregnancy which was made by in vitro fertilization using recombinant follicle stimulating hormone and gonadotropin releasing hormone antagonist. MATERIAL AND METHOD: Case report. RESULTS: Six oocytes were retrieved and all were fertilized by intracytoplasmic sperm injection. Six embryos were transferred and the pregnancy was confirmed. CONCLUSION: It is envisaged that the availability of recombinant gonadotropins and gonadotropin releasing hormone antagonists will ultimately lead to shorter, cheaper and safer treatments, using reduced dosages.
Pregnancy ; Female ; Humans

No abstract available.
Heat-Shock Proteins* ; Hot Temperature*