Postpartum hemorrhage caused by a right gastoepiploic arterial pseudoaneurysm after Cesarean delivery

( Yung Taek Ouh ),( Hye Mi Jin ),( Ji Hye Lee ),( Yeon Sun Kim ),( Hye Ri Hong ),( Geum Joon Cho ),( Min Jeong Oh ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

BACKGROUND: Pseudoaneurysm is a rare but life-threatening cause of postpartum hemorrhage. Especially, gastroepiploic pseudoaneurysm is extremely rare. We reported the case with this rare disease, and reviewed the literature. CASE: A 41-year-old, primigravida pregnant woman had been hospitalized for preterm contraction. She suddenly developed preeclampsia at gestational age of 36+3 weeks, and underwent emergency cesarean section. Immediately after operation, as intra-abdominal distention with a significant decrease of hemoglobin level developed, we did exploratory laparotomy. However, About 4 liter of intraabdominal hemoperitoneum but no active bleeding site around uterus was found. Diagnostic angiography was performed to find bleeding focus. On angiography, pseudoaneurysm with extravasation from hypertrophied omental branch of right gastroepiploic artery was found. The patient was successfully treated with selective embolization. CONCLUSION: Pseudoaneurysm is an infrequent, life-threatening event and requires aggressive resuscitation as initial management and stabilization of the postpartum hemorrhage. Gastroepiploic arterial pseudoaneurysm should be considered when you cannot find cause of postpartum hemorrhage.

Adiponectin promotes angiogenesis via CXCL1 in ovarian cancer

( Yung-taek Ouh ),( Na Young Bae ),( Yoo Jin Lee ),( Sung Eun Kim ),( Hyun Woong Cho ),( Jae-kwan Lee ),( Jin Hwa Hong ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: Adiponectin is a cytokine secreted from adipose tissue with regulating energy homeostasis, inflammation, and cell proliferation. Obesity is associated with the risk of various cancer including ovarian cancer. Adipokines, including adiponectin, have been implicated as a factor linking obesity and carcinogenesis. The oncogenic role of adiponectin has been controversial in several cancer types. We sought to determine the association of adiponectin with angiogenesis in ovarian cancer. Methods: To identify independent angiogenic role of adiponectin on ovarian cancer, vascular endothelial growth factor (VEGF) small interfering RNA (siRNA) was transfected into SKOV3 cells. VEGF-knockdown SKOV3 cell lines were treated with adiponectin for 48 hours. The cytokines involved in adiponectin-mediated angiogenesis were explored by using human angiogenesis cytokine array and were verified with enzyme-linked immunosorbent assay (ELISA). The angiogenic effect of adiponectin was identified by tube formation assay in human umbilical vein endothelial cells (HUVEC). Results: The number of tubes formed by HUVEC significantly decreased following transfection with VEGF siRNA, but treatment of adiponectin conversely increased the number of tubes. To determine which cytokine or chemokine is affected by adiponectin, we conducted angiogenesis-related cytokine array and found that CXC chemokine ligand 1 (CXCL1) was overexpressed after adiponectin treatment, which were further confirmed with ELISA. The secretion of CXCL1 was increased by adiponectin in both SKOV3 cells and VEGF-knockdown SKOV3 cells. Conclusion: Adiponectin treatment of the ovarian cancer cell induced angiogenesis via CXCL1 independently of VEGF, suggesting that adiponectin may serve as a therapeutic target for ovarian cancer.

GO-48 : Type-specific persistence or regression of human papillomavirus genotypes in women with cervical intraepithelial neoplasia 1; a prospective cohort study

( Yung Taek Ouh ),( Kyeong A So ),( Jae Kwan Lee ),( Jin Hwa Hong ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

Prevalence and Treatment of Vulvar Cancer From 2014−2018: A Nationwide Population-Based Study in Korea

Yung-Taek Ouh,Dongwoo Kang,Hoseob Kim,Jae Kwan Lee,Jin Hwa Hong 대한의학회 2022 Journal of Korean medical science Vol.37 No.4

Background: Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. Methods: Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. Results: A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients’ age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; P < 0.001). Conclusion: Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.

Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

Ouh Yung-Taek,Park Ji Jeong,Kang Minjoo,Kim Miseon,Song Jae Yun,Shin So Jin,Shim Seung-Hyuk,Yoo Heon Jong,Lee Maria,Lee Sung-Jong,Shin Whan,Chong Gun Oh,Choi Min Chul,Choi Chel Hun,Min Kyung-Jin 대한의학회 2021 Journal of Korean medical science Vol.36 No.24

Background: Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors. Methods: Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected. Results: In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19–88) years and mean BMI was 22.5 (16.9–34.1) kg/m2 . The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475–3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367–0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385–2.469). Conclusion: Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.

A report of adenexal torsion: 243 cases for 10-years

( Yung Taek Ouh ),( Kyeong A So ),( Kyung Jin Min ),( Jae Kwan Lee ),( Nak Woo Lee ),( Kyu Wan Lee ) 대한산부인과학회 2011 대한산부인과학회 학술대회 Vol.97 No.-

Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment

( Yung-taek Ouh ),( Hyun Woong Cho ),( Seong Min Kim ),( Kyung-jin Min ),( Sang-hoon Lee ),( Jae-yun Song ),( Jae-kwan Lee ),( Nak Woo Lee ),( Jin Hwa Hong ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.5

Objective This study aimed to investigate the clinicopathologic risk factors for type-specific persistence of high-risk human papillomavirus (hrHPV) and residual/recurrent cervical intraepithelial neoplasia (CIN) after surgical treatment. Methods Patients with CIN-2/3 who underwent conization or loop electrosurgical excision procedure (LEEP) at Korea University Hospital were enrolled. All patients underwent hrHPV testing and genotyping before conization or LEEP followed by both hrHPV genotyping and cytology. The significance of associations between patient characteristics and persistence of infection were assessed by multivariate logistic regression analyses. Results Among 398 women with pathologically confirmed CIN-2/3, 154 (38.7%) patients showed hrHPV persistence after surgical treatment. In multivariate analysis, high preoperative hrHPV load (P<0.05; odds ratio [OR], 2.063), presence of CIN-2 at treatment (P<0.01; OR, 2.732), and multiple hrHPV infections (P<0.001; OR, 4.752) were associated with hrHPV persistence. HPV 53 was the most likely to persist after treatment (24/43, 55.8%). The risk of residual/recurrent CIN-2/3 was higher in persistent infection with HPV 16 than other types (P<0.05). Menopause (P<0.001; OR, 3.969), preoperative and postoperative hrHPV load (P<0.05; OR, 2.430; P<0.05; OR, 5.351), and infection with multiple hrHPV types (P<0.05; OR, 2.345) were significantly related to residual/recurrent CIN following surgical treatment. Conclusion HPV load before treatment and infection with multiple hrHPV types were predictors of postoperative hrHPV persistence. HPV 53 was the type most likely to persist, but HPV 16 was the type that was most closely associated with residual/recurrent CIN-2/3.

Preoperative total cholesterol is predictive of prognosis in epithelial ovarian cancer

( Yung-taek Ouh ),( Na Young Bae ),( Yoo Jin Lee ),( Sung Eun Kim ),( Hyun Woong Cho ),( Jin Hwa Hong ),( Jae-kwan Lee ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: To investigate the prognostic implication of preoperative total cholesterol (TC) level in patients with epithelial ovarian carcinoma (EOC). Methods: Medical records of patients who underwent primary debulking surgery and adjuvant platinum-based chemotherapy from January 2002 and December 2015 were reviewed. The association among preoperative TC level, clinical prognostic factors, and outcome as progression free survival (PFS) and overall survival (OS) was analyzed by univariate analysis. To explore independent prognostic factors for PFS and OS, multivariate Cox proportional hazard regression was used. Results: Of total 121 patients, 99 (81.8%) had lower TC (<200 mg/dL) and 22 (18.2%) had higher TC (200 mg/dL). Higher preoperative TC was significantly associated with lower histologic grade (grade 1 or 2) and histology of mucinous and endometrioid. The patients with lower TC showed higher mortality rate (P=0.018). Patients with higher preoperative TC had a longer PFS (P=0.012) and OS (P=0.021). In multivariate analysis, preoperative TC showed a significant association with OS (HR, 0.111; 95% confidence interval [CI], 0.015-0.827, P = 0.032). Conclusion: Higher TC most likely leads to better overall survival in patients with EOC. These results suggest that the level of preoperative cholesterol could assist the identification of patients with poor prognosis in patients with EOC.

Proposal for cervical cancer screening in the era of HPV vaccination

( Yung-taek Ouh ),( Jae Kwan Lee ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.3

Eradication of cervical cancer involves the expansion of human papillomavirus (HPV) vaccine coverage and the development of efficient screening guidelines that take vaccination into account. In Korea, the HPV National Immunization Program was launched in 2016 and is expected to shift the prevalence of HPV genotypes in the country, among other effects. The experiences of another countries that implement national immunization programs should be applied to Korea. If HPV vaccines spread nationwide with broader coverage, after a few decades, cervical intraepithelial lesions or invasive cancer should become a rare disease, leading to a predictable decrease in the positive predictive value of cervical screening cytology. HPV testing is the primary screening tool for cervical cancer and has replaced traditional cytology-based guidelines. The current screening strategy in Korea does not differentiate women who have received complete vaccination from those who are unvaccinated. However, in the post-vaccination era, newly revised policies will be needed. We also discuss on how to increase the vaccination rate in adolescence.

Overview of Malignancy in Pregnancy

( Yung-taek Ouh ),( Geum Joon Cho ),( Sunghun Na ) 대한주산의학회 2020 Perinatology Vol.31 No.4

The incidence of cancer during pregnancy is increasing although it is relatively rare, which is expected to rise with an increase in the maternal age of the pregnancy. Due to the ambiguity of the symptoms, the diagnosis of cancer is often delayed. Diagnosis of cancer in pregnancy needs complex management issues that balance the benefit of treatment for the mother and harm for the fetus. Every patient should be personalized with a multidisciplinary system of obstetricians, gynecologists, oncologists, radiologists, and neonatal specialists and it should assist patients in making informed decisions about the best diagnosis and management for mother and fetus. Radiotherapy, chemotherapy, and surgery could be provided as a management option. In most cancer, pregnancy did not seem to have an adverse effect on maternal prognosis. In this article, we review various perspectives on the diagnosis and treatment of cancer during pregnancy as well as the prognosis of cancer in pregnancy.