OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders complicating pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. But selective screening based on clinical or historic risk factors has been reported ineffective to identify the women with GDM. BACKGROUND: Circulating sex hormones have a role in the development of insulin resistance associated with certain physiological states including hyperandrogenism and polycystic ovary syndrome. Throughout pregnancy, normal human pregnancy is a hyperestrogenic state of major proportions. To evaluate the clinical correlation between Gestational diabetes mellitus and unconjugated estriol, we used it to screening protocol using three biochemical markers for unconjugated estriol levels. METHODS: In our retrospective between January 2002 and December 2003 at Korea university medical center, 137 women were screened for three biochemical tests and 50 gm Glucose challenge test at second trimester of pregnancy. The 50 gm GCT positive (n=56) women were performed 100 gm oral glucose tolerance test and by NDDG diagnosic criteria, women were diagnosed as Gestational diabetes mellitus (n=42). RESULTS: With logistic regression analysis, the significant risk factors were family history of DM (odd ration 16.59 95% CI 2.66-103.52), previous macrosomia birth (odd ratio 9.02 95% CI 1.98-41.6), maternal BMI (odd ratio 1.29 95% CI 1.09-1.49), parity (odd ratio 0.31 95% CI 0.11-0.83), glucosuria (odd ratio 0.68 95% CI 0.26-1.76) and among three biochemical test, estriol (odd ratio 1.60 95% CI 0.49-5.27), AFP (odd ratio 1.35 95% CI 0.35-5.28), hCG (odd ratio 0.59 95% CI 0.27-1.28). CONCLUSION: The screening test of GDM would be preferable and intensified management approach needed for patients with obesity, previous macrosomia birth. In three biochemical test, estriol and AFP levels were elevated in GDM but these odd ratio were not statistically significant.
Academic Medical Centers ; Biomarkers ; Cesarean Section ; Diabetes, Gestational* ; Early Diagnosis ; Estriol* ; Female ; Glucose ; Glucose Tolerance Test ; Gonadal Steroid Hormones ; Humans ; Hyperandrogenism ; Hyperbilirubinemia ; Hypocalcemia ; Hypoglycemia ; Insulin Resistance ; Korea ; Logistic Models ; Mass Screening ; Obesity ; Parity ; Parturition ; Polycystic Ovary Syndrome ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, Second ; Retrospective Studies ; Risk Factors

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.
Fallopian Tubes ; Female ; Fertility ; Humans ; Leucovorin ; Methotrexate* ; Patient Selection ; Pregnancy ; Pregnancy, Ectopic* ; Retrospective Studies

Samonella infection is usually a short febrile self-limiting disease localized to the gut, acquired by ingestion of contaminated food or water. The infection is seldom accompanied by extraintestinal complication. If such a complication does occur, the abscess is often located in bone and periost. Isolated suppurative ovarian infections are rare, but have descirbed, particularly in dermoid cysts, cystadenomas or endometrioma. We report a case of a patient with a Salmonella typhi infection in a serous cystadenoma.
Abscess* ; Cystadenoma ; Cystadenoma, Serous ; Dermoid Cyst ; Eating ; Endometriosis ; Female ; Humans ; Salmonella typhi* ; Salmonella* ; Water

Benign cystic teratoma is the common ovarian tumor, and the incidence reported about 20%. Malignant transformation of mature cystic teratoma of the ovary is rare, which can develop with an incidence of less than 2%. The most common malignant tumor arising in mature cystic teratoma is squamous cell carcinoma which account for 75-85%, but vary rare cases of anaplastic carcinoma arising from mature cystic teratoma has been reported all over the world and prognosis of this malignant tumor was poor. No case of anaplastic carcinoma has been reported before in Korea. We experienced a case of anaplastic carcinoma arising from mature cystic teratoma of the ovary and report our case with a brief review of literature.
Carcinoma* ; Carcinoma, Squamous Cell ; Female ; Incidence ; Korea ; Ovary* ; Prognosis ; Teratoma*

OBJECTIVE: To assess the capability of phosphodiesterase type IV inhibitor (rolipram) to suppress IL-12 in human decidua and the subsequent changes of Th-2 cytokine (IL-10) and Th-1 cytokine (TNF-alpha). METHODS: Decidual tissues of 10 first-trimester pregnant women and 10 first-trimester pregnant women diagnosed as missed abortion were collected by dilatation and currettage. The decidual tissues were treated with rolipram for 6 hours. Protein and mRNA expression in the tissues were analysed by western blotting, immunohistochemistry and reverse transcription-polymerase chain reaction. RESULTS: Rolipram, in the concentration above 1 microgram/ml, could decrease the expression of IL-12p35 (control: 46.37+/-7.38, rolipram: 24.34+/-8.46) and IL-12p40 mRNA (control: 31.7+/-5.8, rolipram: 14.9+/-4.6) and protein (control: 52.4+/-8.9, rolipram: 40.9+/-12.1). However, the expression of IL-10 and TNF-alpha mRNA and protein did not changed by rolipram. There was no difference in the cytokine expression pattern between the decidual tissues of normal pregnancy and missed abortion. CONCLUSION: Rolipram, the phosphodiesterase type IV inhibitor, could induce the decrease of IL-12 in human decidua. In human decidual tissue, unlike other human tissues, the decrease of IL-12 by rolipram did not modulate other Th-1/Th-2 cytokines. Inability of IL-12 to modulate other Th-1/Th-2 cytokines might be related with unique cytokine network in human decidua rather than its small extent of decrease.
Abortion, Missed ; Blotting, Western ; Cyclic Nucleotide Phosphodiesterases, Type 4* ; Cytokines* ; Decidua ; Dilatation ; Female ; Humans* ; Immunohistochemistry ; Interleukin-10 ; Interleukin-12 Subunit p35 ; Interleukin-12 Subunit p40 ; Interleukin-12* ; Pregnancy ; Pregnant Women ; RNA, Messenger ; Rolipram ; Tumor Necrosis Factor-alpha

OBJECTIVE: The aim of this study was to determine clinical significance of weight difference in twin pregnancies. METHODS: The medical records of 157 sets of twin pregnancies delivered between 1992 and 2001 were reviewed retrospectively. Birth weight differences were stratified 3 categries; 15% or less, 16-30%, 31%, or more. x2 stastics and ANOVA was used. RESULTS: The degree of difference correlated strongly with risk for SGA, RDS, Sepsis, Length of hospital stay, congenital anomaly, perinatal mortality but there were no increment in PDA and preterm delivery. There were no differences in outcomes for the smaller compared with larger twin of the twin pair. Maternal complications such as preeclampsia was increased in weight discordant twin. CONCLUSION: Twin birth weight difference was closely related to adverse perinatal outcome. In severe intrapair weight difference (31% or more), all cases showed fetal death, which means physicians need to consider pregnancy termination. Birth weight discordance was a very complex problem. In the management of discordant twin, more frequent antenatal care and closer observation was recommended.
Birth Weight* ; Fetal Death ; Humans ; Length of Stay ; Medical Records ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies ; Sepsis

PURPOSE: The biallelic expression of insulin-like growth factor-II (IGF2) and H19 has been reported to be associated with the progression of several tumors. Here, the promoter usage and expression levels of IGF2 and H19 are reported to be altered in cervical and endometrial cancers showing loss of imprinting (LOI). MATERIALS AND METHODS: The imprinting status of IGF2 and H19 was examined in 32 cervical carcinomas, their matched normal tissues, 13 endometrial cancer and 33 normal endometrial tissues. RESULTS: The LOI of IGF2 was observed in 7 of 18 (39%) and 1 of 13 (8.3%) informative cervical carcinomas and informative endometrial cancers, respectively. The LOI of the H19 gene was detected in 5 of 14 (36%) and in all 11 (100%) informative cervical carcinoma cases and informative endometrial cancer cases, respectively. The use of promoter P1 was observed in the LOI tumors of IGF2, but not in the tumors showing maintenance of IGF2 imprinting (MOI), or in cervical and endometrial cancers. Unlike MOI tumors, some LOI tumors revealed a lack of IGF2 transcription from the promoter P3. The LOI tumors of IGF2 showed increased expression of the IGF2 level, but a down-regulation of the H19, relative to normal tissues, whereas the MOI tumors revealed no significant alterations. CONCLUSION: These results suggest that the promoter P1 could be involved in the biallelic expression of IGF2, and that the altered expression of the IGF2 and H19 levels might be associated with the progression of cervical and endometrial cancers that exhibit biallelic IGF2 expression.
Down-Regulation ; Endometrial Neoplasms* ; Female ; Uterine Cervical Neoplasms

OBJECTIVE: To find out wheather the substance P takes part in the pain mediating system of uterus, and to ascertain the role of substance P in the hypersensitivity of hypogastric nerve to bradykinin during the uterine inflammation. METHODS: The uterus has two sensory innervations, which are the hypogastric nerve and the pelvic nerve. Since the hypogastric nerve is known to show increased sensitivity to bradykinin, a pain mediator, when the uterus is in inflammatory state, the hypogastric nerve recording was done for electrophysiological study of uterine pain-mediating mechanism in female SD rats (200-250 g). NK1 receptor antagonist (L-703,606) was injected through uterine artery before injecting bradykinin while uterus was under inflammation. RESULTS: The NK-1 receptor antagonist (L-703,606) decreased the spontaneous nerve impulse during inflammation, and it also decreased the hypersensitivity of the hypogastric nerve to bradykinin during the uterine inflammation. CONCLUSION: Substance P mediates the pain sense of hypogastric nerve, and it also plays a role in increased sensitivity of hypogastric nerve to bradykinin while uterus is in inflammatory state.
Action Potentials ; Animals ; Bradykinin* ; Female ; Humans ; Hypersensitivity ; Inflammation ; Mustard Plant* ; Negotiating ; Rats* ; Receptors, Neurokinin-1* ; Substance P ; Uterine Artery ; Uterus*

OBJECTIVE: Recently some reports suggested substance P and CGRP might be important factors for inflammation and hyperalgesia. This study was performed to see whether substance P or CGRP containing nerve fibers might be changed by mustard oil-induced inflammation. METHODS: After injection of mustard oil(5%) into uterine lumen, the uteri were removed and examined with immunohistochemical methods for substance P and CGRP. RESULTS: In the normal uterus, most of the substance P- or CGRP-immunoreactive nerve fibers were observed along the vascular structure and some in the myometrium, only few in the endometrium. Mustard oil did not changed this pattern of nerve fiber distribution but after 48 hrs, the amount of substance P or CGRP immunoreactive nerve fibers were greatly reduced compared with the normal uterus. It is not clear whether the decrease of substance P and CGRP immunoreactive fibers in the uterus was resulted from the depletion of the neuropeptides in the nerve fibers or the retraction of nerve fibers. CONCLUSIONS: These results suggest that the inflammation should cause the change of nerve fibers included in the nociception. This change may attribute the generation of inflammation and inflammatory hyperalgesia.
Animals ; Endometrium ; Female ; Hyperalgesia ; Inflammation* ; Mice ; Mustard Plant ; Myometrium ; Nerve Fibers ; Neuropeptides ; Nociception ; Rats* ; Substance P* ; Uterus*

OBJECTIVE: In inflammation, hyperalgesia is a common phenomenon but its mechanism has not been clarified. Recently some reports suggested substance P might be important factors for inflammatory hyperalgesia in somatic tissue. This study was performed to see whether substance P modulate the activities of uterine afferent fibers in the hypogastric nerve of the cat. METHODS: While recording the electrical activities of nerve fibers, mechanical stimuli were applied as balloon distention using balloon inserted into uterine lumen before and during substance P infusion through uterine artery. RESULTS: Substance P increased the responses to balloon distension of uterus in 14 uterine mechanoreceptive afferent fibers of 24 over 10% compared to before substance P infusion, and decreased the responses of 3. And L-703,606, the neurokinin 1 receptor antagonist failed the modulation of mechano sensitive response by substance P and reduced the spontaneous activities. CONCLUSIONS: These results suggest that substance P modulated the activities of uterine nerve fibers and their responses to mechanical stimulus. It is hypothesized that this kind of modulation of afferent nerve fibers by substance P may be important for the development of inflammatory hyperalgesia.
Animals ; Cats ; Hyperalgesia ; Inflammation ; Mechanoreceptors* ; Nerve Fibers ; Receptors, Neurokinin-1 ; Substance P* ; Uterine Artery ; Uterus