복강경술을 이용한 난소 병변의 치료

임윤경(Yun Kyoung Lim),김영아(Young Ah Kim),조미영(Mi Yeong Jo),안상태(Sang Tae Ahn),유희석(Hee Sug Ryu),김미란(Mi Ran Kim),황경주(Kyung Joo Hwang) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.4

Objective : To assess the advantages, disadvantages, applicability, and complications of operative laparoscopy in ovarian pathologic lesions. Materials and Methods : A retrospective case series which compares 354 patients who had laparoscopic surgery at Ajou University Hospital from June, 1994 to September, 2001 for ovarian pathology. Results : The patient`s ages ranged from 13 to 77 years, and their mean age was 30.9 years. Most of the lesions were less than 7 cm in size and unilateral. The operations performed were cystectomy in 225 cases (63.6%), salpingooophorectomy, oophorectomy, salpingectomy and fenestration or biopsy in order. Operative times were between 10 and 240 minutes (mean: 74.2 minutes). Pathologic examinations of unilateral ovarian tumors were performed in 305 cases. The most common pathology of unilateral ovarian tumor was teratoma (107/305, 35.1%), endometrioma and cystadenoma in order. Malignancies were found in 4 cases including borderline malignancy (1.3%). Pathologies of bilateral ovarian tumor were endometrioma (31/41, 75.6%), teratoma, and fibroma in order. Postoperative hospital stays were from 0 days to 19 days (mean: 2.5 days). There were 7 surgical complications including 3 vessel injury related hematomas, 1 abscess formation, and 3 exploratory laparotomy. Conclusions : We concluded that operative laparoscopy was useful in surgery of ovarian lesions, if there are carefully selected patients, standard procedures, and skilled laparoscopic surgeons.

자궁내막증 환자의 자궁내막내 성호르몬 수용체, Integrins, Cyclooxygenase의 발현과 변이 양상

김미란,박동욱,권혁찬,황경주,주희재,조동제,김세광,오기석,Kim, Mi-Ran,Park, Dong-Wook,Kwon, Hyuek-Chan,Hwang, Kyoung-Joo,Joo, Hee-Jae,Cho, Dong-Jae,Kim, Sei-Kwaug,Oh, Kie-Suk 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.2

Objectives: To develop a new immunohistochemical marker system for supplementation of the Noyes histological classification of the endometrium in women of child bearing age with regular menstrual cycles, and to employ this system to evaluate pathologic factors involved in endometriosis, and thus to ascertain if it is useful in diagnosis. Materials and Methods: Endometrial biopsies were sampled from the posterior fundus of 41 (24 proliferative phases, 17 secretory phases) women with regular menstrual cycles (28-32 days), and each sample was immunohistochemically stained according to Noyes et al (1975) for determination of expression for estrogen receptor (ER), progesterone receptor (PR), integrin ${\alpha}_1$, ${\alpha}_4$, ${\beta}_3$, COX-1 and COX-2. Then, the PR, integrin ${\beta}_3$ and COX-2 which were clearly expressed in the luteal phase was with endometrial samples were obtained from 20 cases of normal patients (group 1) and 25 cases with endometriosis (group 2) after confirming the day of ovulation by sex steroid level measurements 7-8 days after ovulation Results: In the regular menstruation group the expression of ER showed a tendency to be increased in the proliferative phase and decreased in the secretory phase, and was the highest in the proliferative phase. However, PR in the stromal cells showed no change in the entire menstrual cycle while in the epithelial cells, PR reached a peak in the late proliferative phase and was almost absent in the secretory phase. Integrin (${\alpha}_1$, ${\alpha}_4$, and ${\beta}_3$ expression in the epithelial cells was absent in the proliferative phase but ${\alpha}_1$ was strongly expressed starting from the early secretory phase into the entire secretory phase. ${\alpha}_4$ was expressed strongly in the early and mid secretory phases and disappeared in the late proliferative phase, while ${\beta}_3$ appeared after the mid secretory phase and continued to be expressed until the late secretory phase. Expression in the stromal cells was weak overall and did not show any cyclic pattern. COX-1 expression was shown as a cyclic pattern in the stromal and epithelial cells and was particularly strongly expressed in the mid secretory phase of epithelial cells, and in the mid secretory and menstruation phase of stromal cells. In the endometrial epithelial cells there was strong expression during the entire cycle with stronger expression in the secretory phase compared to the prolferative phase. COX-2 was clearly expressed in the late proliferative, early and mid secretory phases in the stromal cells. No expression was observed in the proliferative phase of the epithelial cells, but which began to appear in the early secretory phase reaching a significant pattern from the mid secretory phase onwards. There was almost no expression in the stromal cells. In the cases with endometriosis showing normal endometrial maturation according to the Noyes classification, PR expression was increased while Integrin-${\beta}_3$의 expression was significantly decreased compared to the normal group. Also, COX-2 expression was slightly decreased in the stromal cells of patients with endometriosis while it was significantly increased in the stromal cells. Conclusion: Immunohistochemical markers can supplement the original Noyes classification of histological endometrial dating and therefore ascertain existing pathologic conditions. Particularly for patients with endometriosis with normally mature endometrial cells, changes in COX-2 and integrin expression patterns may assist in elucidating pathophysiologic mechanisms and therefore aid in the diagnosis of abnormal implantation conditions, and consequently determine a treatment modality.

착상관련 질환 환자의 자궁내막에 있어서 프로게스테론 수용체, integrinβ₃, cyclooxygenase-2(COX-2)의 발현 양상

이준서(June Seo Lee),박동욱(Dong Wook Park),권혁찬(Hyuck Chan Kwon),김미란(Mi Ran Kim),황경주(Kyoung Joo Hwang),주희재(Hee Jae Joo),조동재(Dong Jae Cho),김세광(Sei Kwang Kim),오기석(Kie Suk Oh) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

Objective : We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium.Study design : Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ∼ 8 days after ovulation (POD 7 ∼ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. Results : PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. Conclusions : In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.

ATP 에 의해 유도된 인간 난소 황체화 과립세포의 세포자멸사에 관한 연구

김미란(Mi Ran Kim),박동욱(Dong Wook Park),김영아(Young Ah Kim),조태섭(Tae Seop Cho),황경주(Kyung Joo Hwang),임윤경(Yun Kyoung Lim),민철기(Churl K . Min) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.11

Objective : To determine the effects of extracellular ATP on mitochondrial function and apoptosis during human luteinized granulosa cell cultures. Methods : The addition of various concentrations of ATP (0, 0.1, 0.25, 0.5, 0.75 mM) to luteinized granulosa cells obtained during In vitro fertilization ovum pickup procedures. After culture for 24 hours, purinoceptor activity and functional changes in mitochondria were measured by patch clamp, flow cytometry, and confocal microscopy. Results : Measurement by patch clamp of the granulosa cell membrane potential after ATP addition to cultured granulosa cells showed that both the inward and outward currents were expressed. After treatment of the granulosa cells with JC-1, measurement of the mitochondrial activity by confocal microscopy showed that the with increasing concentrations of ATP the relative ratio of undamaged mitochondria (red/green ratio) tended to decrease (P=0.027). After double staining of the cultured granulosa cells with Annexin V and Propidium Iodide, quantitative flow cytometry analysis showed that apoptosis increased with increasing concentrations of ATP (7.88%, 8.44%, 11.40%, 13.52%, 18.57%). Conclusion : The results of this study shows that apoptosis of granulosa cells increases with increasing extracellular ATP concentrations in cultured human luteinized granulosa cells. This is observed to be a consequence of cell membrane purinoceptor activity and functional changes in the mitochondria. It is therefore thought that remodelling processes of the ovarian tissue is regulated by neuroendocrine factors of the extracellular ATP.