Invasive Extramammary Paget's disease of the vulva

( Eunwook Joo ),( Eun-joo Son ),( Yeonseong Jeong ),( Yunjin Bang ),( Jeongmin Song ),( Kyung-do Ki ),( Seonkyung Lee ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Extramammary Pagets disease is a rare, slow-growing skin neoplasm. Extramammary Pagets disease of the vulva (EPDV) counts less than 1% of all vulvar malignancies. Because of its rarity and unpredictable disease course, diagnosis is delayed. The deep invasion (≥1mm depth) has been reported as poor prognosis because spread through the epidermal basal membrane results in a high percentage of nodal metastasis and a low survival rate. Thus, patients with invasive EMPD can be treated less successful than in situ tumor. Although reports of EPDV have been reported often in dermatology, they have rarely been reported as gynecologic papers in Korea. In order to identify in the clinical course and treatment of EMPD in Korean patients, we present here a case of a 69-year-old woman with DM and HTN, admitted to the gynecological department because of right side of vulvar itching sensation. Prior to our hospital visit, the patient underwent right vulvar lesion biopsy on August 19, 2017 at local gynecology hospital. Histopathologic result of her skin biopsy was reported as compound nevus and there was no evidence of malignancy. At the time of our hospital on June 26, 2018, her Right vulvar lesion was entirely involved and had erythematous patches and nodules with erosion and discolored lesion. Right vulvar lesion excision under general anesthesia was performed again on July 06, 2018. Unlike the previous biopsy, histologic result was reported extramammary Paget disease with 5mm invasion depth. Surgical treatment was performed on July 23, 2018: bilateral vulvectomy without pelvic lymphadenectomy using frozen section analysis of excision margins. The final histopathologic examination revealed an Extra-mammary Paget's disease with focal stromal invasion at right vulva. We are currently undergoing outpatient follow-up due to improved symptoms.

The reduction of the rate of uterine fundal pressure maneuvers by an inflatable obstetric belt in nulliparous women: A preliminary study

( Eunwook Joo ),( Ji Young Park ),( Gwan Hee Han ),( Do Youn Kwon ),( Jungsoo Chae ),( Eunjoo Son ),( Yeonseong Jeong ),( Hyun-joo Seol ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: Uterine fundal pressure maneuver has been frequently used in laboring women to help pushing the baby with doubtful efficacy and safety. The inflatable obstetric belt is synchronized to adapt consistent fundal pressure during a uterine contraction. Its efficacy of decreasing the duration of the second stage of labor without remarkable complications in nulliparous women has been proven. The aim of this study was to determine whether or not the inflatable obstetric belt reduces the rate of uterine fundal pressure in the management of the second stage of labor in nulliparous women. 방법: Thirteen nulliparous women with a singleton cephalic pregnancy above 37+0 weeks gestation in the second stage of labor were enrolled. The control cohort group was 29 primiparous women who underwent the same criteria with standard care. All participants in the active group wore the belt (Baidy M-600/Curexo, Inc., Seoul, Korea) at the end of the first stage of labor and the inflatable belt was started at the beginning of the second stage and maintained until delivery of a baby. The primary outcome was the rate of fundal pressure maneuvers in the second stage of labor. The secondary outcomes were the duration of labor, rates of cesarean section, perineal laceration, and perinatal outcomes. 결과: There were no significant differences between the active group and the control group according to the maternal and fetal demographic variables. The active group showed a significantly decreased the rate of fundal pressure maneuvers as compared to the control group (23.07% vs. 100.00%, p=0.02). Duration of the second stage of labor was shorter in the active group than in the control group (43.23±19.02 min vs. 67.51±32.80 min, p=0.008). There was no difference in the rates of cesarean section, perineal laceration, and perinatal outcomes between the two groups. 결론: The results of the preliminary study demonstrate that the use of the inflatable obstetric belt significantly decreases the rate of fundal pressure maneuvers during the second stage of labor in nulliparous women.

Delayed interval delivery in twin pregnancies with spontaneous delivery before viability:The role of cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone

( Eunwook Joo ),( Kwanghee Ahn ),( Hyeon Ji Kim ),( Jee Yoon Park ),( Kyung Joon Oh ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: The aim of this study was to evaluate the proportion eligible for delayed interval delivery, and the efficacy of cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone in prolonging the gestation in twin pregnancies with spontaneous delivery before viability. Methods: This was a retrospective study including 17 consecutive dichorionic twins of which presenting fetus had been spontaneously delivered before viability(15.0-22.9 weeks) from January 2015 to June 2020. Cases without active labor pain within 6 hours after delivery of the first fetus were considered to be eligible for delayed interval delivery. Cervical cerclage combined with adjuvant broad-spectrum antibiotics and vaginal natural progesterone was performed in eligible cases. Obstetric outcomes and neonatal outcomes of the remaining fetus were analyzed. Results: About 41% of patients(7/17) were not delivered within 6 hours after delivery of the first fetus. Among the 7 patients undelivered within 6 hours, two patients did not undergo cervical cerclage because of suspected chorioamnionitis(n=1) or preterm premature rupture of membrane(n=1). Five cases(29.4%) underwent cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone use. The median interval from cervical cerclage to delivery was 111 days (range: 39-119 days) and the median gestational age at delivery was 34.9 weeks (range: 27.6-37.0 weeks). The rate of patients undelivered at 32, 34 and 36 weeks was 80%(4/5), 60%(3/5), and 40%(2/5). All the 5 neonates survived without major morbidity except mild chronic lung disease in one case born at 27.6 weeks. Conclusion: About 29% of twin pregnancies with spontaneous delivery of the first fetus before 23 weeks were eligible for delayed interval delivery. Cervical cerclage combined with adjuvant broad-spectrum antibiotics and natural progesterone use seems to help maintain the pregnancy of remaining fetus after spontaneous delivery before 23 weeks in twin pregnancies.

Maternal Plasma and Amniotic Fluid LBP, Pentraxin 3, Resistin, and IGFBP-3: Biomarkers of Microbial Invasion of Amniotic Cavity and/or Intra-amniotic Inflammation in Women with Preterm Premature Rupture of Membranes

Joo Eunwook,Park Kyo Hoon,Kim Yu Mi,Ahn Kwanghee,Hong Subeen 대한의학회 2021 Journal of Korean medical science Vol.36 No.44

Background: We sought to determine whether lipopolysaccharide binding protein (LBP), pentraxin 3, resistin, and insulin-like growth factor binding protein (IGFBP)-3 in plasma and amniotic fluid (AF) can predict microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and microbial-associated IAI in women with preterm premature rupture of membranes (PPROM). Methods: This was a retrospective cohort study involving 168 singleton pregnant women with PPROM. AF obtained via amniocentesis was cultured and assayed for interleukin (IL)-6 to define IAI and for IL-8 to compare with AF biomarkers. Plasma samples were collected at the time of amniocentesis, and C-reactive protein (CRP) levels in serum were compared with plasma biomarkers. The stored plasma and AF samples were assayed for LBP, pentraxin 3 (PTX3), resistin, and IGFBP-3 by ELISA. Results: Multivariate logistic regression analysis revealed that: 1) elevated plasma and AF levels of LBP were independently associated with increased risks of MIAC, IAI, and microbial-associated IAI; 2) elevated AF, but not plasma, PTX3, and resistin levels were independently associated with increased risks of MIAC, IAI, and microbial-associated IAI; 3) decreased IGFBP-3 levels in the plasma were independently associated with only IAI, whereas those in the AF were associated with only microbial-associated IAI. Among the tested biomarkers, AF PTX3 and resistin had the highest predictive performance for MIAC, IAI, and microbial-associated IAI (area under the curves [AUC] = 0.85–0.95), which is similar to the performance of AF IL-8. The AUCs of the plasma LBP and IGFBP-3 were similar to that of serum CRP with respect to IAI. Conclusion: Maternal plasma LBP and IGFBP-3 are potential biomarkers for the non-invasive identification of IAI in women with PPROM, with a similar accuracy to the serum CRP level. AF LBP, PTX3, resistin, and IGFBP-3 may be involved in the intra-amniotic inflammatory responses in PPROM complicated by MIAC.

Neoadjuvant chemotherapy with a combination of vinblastine, bleomycin, and cisplatin(VBP) followed by surgery in locally advanced squamous cell carcinoma of the vulva : A case report

( Eun-joo Son ),( Eunwook Joo ),( Yeonseong Jeong ),( Yunjin Bang ),( Jeongmin Song ),( Eun-hee Yoo ),( Seon Kyung Lee ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

A 56-year-old female was referred to our gynecological department for evaluation of the vulvar ulceration. The patient suffered from vulvar burning sensation. Physical examination revealed an approximately 7 cm in diameter exophytic cauliflower-like mass with ulcerative growth that involved the both labia minor and the perineum. And both enlarged inguinal lymph nodes were palpable. The serum squamous cell carcinoma antigen level was 4.3 ng/ml. Punch biopsy was performed and the result was reported as SCC of the vulva. Computed tomography showed an enlarged (>5mm) lymph nodes metastasis in the both groin. Due to bulky mass in the vulva, the patient underwent neoadjuvant chemotherapy(NACT) with VBP(vinblastine 4 mg/m2 plus bleomycin 25 mg and cisplatin 50 mg/m2). After the three courses of chemotherapy, the vulvar lesion was greatly reduced in size, while the both groin lymphadenopathy remained unchanged. Subsequently, a radical vulvectomy with bilateral inguinofemoral lymphenectomy was performed. The final histopathological reports of the surgical specimen demonstrated a moderately-differentiated invasive squamous cell carcinoma with negative resection margin. Lymph nodes were positive for metastasis (right inguinal: 3/8, left inguinal: 1/7). 2 month later the surgery, the patient received adjuvant radiotherapy of the vulvar and inguinal regions bilaterally. (external-beam irradiation, 1.8 Gy/day in 25 fractions over 5 weeks ; total radiation dose, 45.0 Gy) Optimal treatment of locally advanced, inoperable vulvar cancer is still debatable. Our case illustrates that NACT with VBP showed significantly decreasing in tumor burden with manageable toxicity. In conclusion, NACT with VBP may increase surgical feasibility in initially unresectable tumor, decrease the deleterious side effect of radiotherapy. Therefore, the use of neoadjuvant chemotherapy followed by surgery could be considered as a therapeutic option for locally advanced vulvar cancer.

Predictors of Acute Postoperative Urinary Retention after Transvaginal Uterosacral Suspension Surgery

Eun-Joo Son,Eunwook Joo,황우연,Mi Hyun Kang,Hyun Jin Choi,유은희 대한폐경학회 2018 대한폐경학회지 Vol.24 No.3

Objectives: To investigate the rate of postoperative urinary retention (POUR) and identify the risk factors for this complication in women who underwent transvaginal uterosacral suspension surgery.Methods: A retrospective chart review was conducted for 75 women who underwent transvaginal uterosacral suspension surgery with vaginal hysterectomy, repair of cystocele, and levator myorrhaphy with/without transobturator anti-incontinence surgery. POUR was defined as a need for continuous intermittent catheterization on the third day subsequent to removal of the urethral indwelling catheter.Results: Acute POUR was reported in 18 women (24.0%). Thirty-six of the 75 patients (48.0%) had undergone anti-incontinence surgery. Crude analysis revealed significant association between the following variables and the risk of POUR: hypertension, the lower average flow rate in the pressure-flow study (PFS), greater post-void residual (PVR) urine volume in PFS, and PVR >30% of the total bladder capacity (TBC) in PFS. In the logistic regression analysis, PVR >30% of the TBC in PFS was identified as the only significant predictor of POUR (odds ratio, 15.4; 95% confidence interval, 2.5-90.9; P = 0.003).Conclusions: The PVR >30% of the TBC in PFS was identified as the only predictive factor of acute POUR in women who underwent transvaginal uterosacral suspension surgery.

스포츠 손상관리 시스템의 운영 실태 조사와 시설 이용 만족도 및 관리자의 직무 만족도 조사를 통한 선수 손상관리 시스템의 개선 방향 연구

남혜주 ( Hae-joo Nam ),장은욱 ( Eunwook Chang ) 한국운동생리학회(구 한국운동과학회) 2020 운동과학 Vol.29 No.3

PURPOSE: The purpose of this study was to investigate athletes’ satisfaction of sports injury management system and athletic trainers’ job satisfaction. METHODS: Total of 183 athletes and 30 athletic trainers responded to the survey. The surveys consisted 25 questions for health care satisfaction from athletes. From factor analysis, there were four subfactors 1) Satisfaction with trainer quality, 2) Activity on the role of the trainer, 3) Satisfaction with injury management system service, 4) The necessity of an athletic trainer) from 25 questions. The survey for athletic trainers consisted to 19 questions and there were five subfactors 1) Relationship and communication, 2) Treatment as an athletic trainer 3) Expectation for working environment change, 4) Proud for the job, 5) Anxiety and inequality in the work environment). One-way analysis of variance was utilized to compare the differences among subfactors in each category. Independent t-test was used to compare the satisfaction with or without athletic trainers. RESULTS: 1) Athletes’ satisfaction: there was a significant difference between the satisfaction with or without athletic trainers in subfactor 2 and 3 (p<.01). The satisfaction of injury management system exhibited that subfactor 2 and 3 showed a significance difference by age (p<.05) and subfactor 1, 2, and 3 (p<.01) showed a significant difference by event participations of athletic trainers. 2) Athletic trainers’ satisfaction: There was a significant difference on subfactor 3 (p<.05) between age 20-26 years old. In addition, there was a significant difference on sub factor 3 (p<.05) by type of sports and on subfactor 2 (p<.05) by career span. CONCLUSIONS: A systematic athletic training education program and the vocational welfare environment of athletic trainer will be necessary for providing a better health care services to athletes.

표면 특성에 따른 다양한 스쿼트 운동 시 하지 근육의 활성도 비교

김수진 ( Soojin Kim ),이주현 ( Joo-hyun Lee ),허지혜 ( Jihye Heo ),장은욱 ( Eunwook Chang ) 한국운동생리학회 2021 운동과학 Vol.30 No.3

PURPOSE: The purpose of this study was to compare thigh muscle activities and muscle co-activation when performing squats, wall squats, and Spanish squats on stable and unstable ground. METHODS: Twenty-two healthy male subjects (age: 22.50±2.70 years, height: 178.72±6.04 cm, mass: 76.50±6.80 kg, body mass index: 24.00±2.10 kg/㎡, and Godin activity questionnaire: 56.30±24.10) voluntarily participated in the study. All of the participants performed three different squat exercises on the floor and the BOSU ball with an electromyograph attached to each participant’s quadriceps (rectus femoris, RF; vastus lateralis, VL; and vastus medialis, VM) and hamstrings (biceps femoris, BF; semitendinosus, ST; and semimembranosus, SM). Repeated measures of analysis of variance were utilized to compare muscle activity during the three squats exercises by floor type. RESULTS: RF (p<.001, η²=.689), VL (p<.001, η²=.622), and VM (p=.002, η²=.375) showed significant differences between exercises. Spanish squats yielded greater BF activity than did wall squats (p=.018, η²=.269). ST yielded greater muscle activity with the BOSU ball than on the floor (p=.018, η²=.269). Finally, there was a significant ground exercise interaction effect on the co-activation, showing greater muscle co-activation with Spanish squats on the BOSU ball compared to squats, squats on the BOSU ball, and wall squat on the BOSU ball. CONCLUSIONS: The findings of this study indicate that Spanish squats could be an effective exercise option for the facilitation of RF, VL, VM, and BF muscle activation. In particular, performing Spanish squats on an unstable surface could be useful for patients who need to improve their quadriceps muscle activation.

Maternal serum sFlt-1/PlGF ratio in suspected preeclampsia with twin pregnancies compared to singleton pregnancies

( Da Eun Jeong ),( Tae Eun Kim ),( Eunwook Joo ),( Kwanghee Ahn ),( Hyeon Ji Kim ),( Jee Yoon Park ),( Kyung Joon Oh ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: To evaluate the maternal serum levels of sFlt-1, PlGF and sFlt-1/PlGF ratio in suspected preeclampsia patients with twin pregnancies compared to singleton pregnancies. Methods: This was a retrospectively study on women who had received the laboratory tests including maternal serum levels of sFlt-1, PlGF and sFlt-1/PlGF ratio for the purpose of evaluation for preeclampsia at Seoul National University Bundang Hospital between March 2019 and June 2020. Two triplet pregnancies were excluded. A total of 104 singleton pregnancies and 35 twin pregnancies were included and divided into groups according to the diagnosis of preeclampsia. Obstetric and neonatal outcomes were compared in the groups classified by the well-known cut-off of the sFlt-1/PlGF ratio: below 38, 38-85, and over 85 in singletons and twins, respectively. Results: Among the study population, 35% (49/139) were diagnosed as preeclampsia (38/66 in singleton pregnancies and 11/35 in twin pregnancies). The levels of sFlt-1 and PlGF were significantly different between twins and singletons when analyzed both in the group without and with preeclampsia (p-values, all < 0.05). However, the sFlt-1/PlGF ratio were comparable between twins and singletons in the group without and with preeclampsia. The rates of preterm birth before 34 weeks of gestation were significantly different according to the cut-offs of the sFlt-1PlGF ratio in singletons (2.8% in below 38 vs. 12.5% in 38-85 vs. 43.8% in over 85, p<0.001), however the difference did not reach statistical significance in twin pregnancies. Conclusion: Unlike the sole level of sFlt-1 or PlGF, the sFlt-1/PlGF ratio in twin pregnancies with preeclampsia is not different from that in singletons. Nevertheless, the predictive value of the sFlt-1/PlGF for the adverse outcomes of preeclampsia seems to be better in singletons than twins.

Nephrin in maternal urine as a simple biomarker to predict preeclampsia

( Tae Eun Kim ),( Eunhae Oh ),( Kiseok Kim ),( Eunwook Joo ),( Kwanghee Ahn ),( Hyeon Ji Kim ),( Subeen Hong ),( Jee Yoon Park ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: Nephrin is a protein identified at the glomerular podocyte slit diaphragm, therefore the presence of nephrin in urine implies damage of podocytes. It has been studied widely in nephropathies and glomerular diseases of adults. This study is to determine the efficacy of nephrin as a biomarker in maternal urine for prediction of preeclampsia. Methods: This was a prospective study on pregnant women who had been admitted for delivery at Seoul National University Bundang Hospital between March 2019 and May 2020. The target sample size was 50 patients with preeclampsia confirmed and 50 cases without any underlying diseases. Urine samples were obtained and nephrin signaling was detected through the test strips using lateral flow assay. Other clinical information was collected as well. Results: The clinical characteristics including maternal age, the rate of nulliparity, the rate of twin pregnancies, height, weight, the rate of cesarean section were comparable between the control group and the preeclampsia group. The signals of nephrin was classified into four groups. In preeclampsia groups, signal 0, 1, 2, and 3 were found in 18.4% (9/49), 44.9% (22/49), 24.5% (12/49), and 12.2% (6/49), respectively. This was significantly different from the control groups since 84.3% (43/51) was found to be signal 0 in the controls (p<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of positive signals (1, 2, and 3) to predict preeclampsia are 82%, 84%, 83%, and 83%, respectively. Conclusion: Nephron signaling in maternal urine might be an easy and accurate screening test for detection of preeclampsia.