• The Korean Journal of Pharmacology
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• v.19 no.1
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• pp.37-60
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• 1983

The uterus receives adrenergic terminals from the mesenteric ganglia and considerably large amount of catecholamines have been shown to be contained in this organ. On the other hand, the activities of epinephrine, norepinephrine or adrenergic nerve on uterine motility is so complicated that many controversial results have been reporter. Recently, a large number of reports concerning the changes of uterine catecholamines content have appeared, but little is known about the role of uterine catecholamines in their activities on uterine motility. The present experiments were undertaken to determine the significance of the intrinsic uterine catecholamines in the physiology of uterus. Female albino rabbits weighing approximately 2 kg were employed in this experiment. uterine strip3 were prepared and suspended in a constant temperature $bath(38^{\circ}C)$ containing 100 ml of Locke's solution aerated with 95% oxygen and 5% carbon dioxide. Spontaneous motility was recorded on a smoked drum with an isotonic lever. The catecholamines concentration of the uterus was determined according to the Procedure described of Shore and Olin (1958). Human uterus obtained from patients was also used to determine the catecholam ines content of myometrium. Followings are summarized results. 1) On the non-pregnant rabbit uterine strips, epinephrine and norepinephrine significantly elevated the tonus and stimulated the spontaneous motility. Pretreatment with dichloroisoproterenol(DCI), an adrenergic beta-receptor blocker, enhanced the stimulatory activity of epinephrine or norepinephrine. On the other hand, pretreatment with dibenamine, an adrenergic alpha-receptor blocker, rendered the uterine muscle to exhibit inhibition after the administration of epinephrine or norepinephrine. Following the treatment with both DCI and dibenamine, epinephrine or norepinephrine produced no appreciable effects on the spontaneous motility of the uterus. These results suggest there exist both alpha and beta-adrenergic receptors in the uterine muscle and the response to epinephrine of the former is predominant over that of latter in the non-pregnant uterus of rabbits. The total catecholamines concentration of the non-pregnant uterus was $351\;m{\mu}g/g$ and the fractional concentrations of epinephrine and norepinephrine were $125\;m{\mu}g/g(35.7%)$ and $226\;m{\mu}g/g$ respectively. It is interesting to note that the catecholamines content of uterus was characterized by a high fractional corcentration of epinephrine relative to norepinephrine. 2) On the pregnant rabbit uterine strips, the effects of epinephrine and norepinephrine varied according to the period of pregnancy. The response to epinephrine of adrenergic beta receptor of uterus increased during pregnancy, and the effect of catecholamine was inhibitory in the early pregnancy but became stimulatory as the pregnancy progressed. This stimulating action on the uterine motility was found to occur through the action of norepinephrine. The uterine catecholamines concentration was markedly reduced during pregnancy. The catecholamines concentration was started to decrease in the early pregnancy, reached the lowest level in the mid-pregnancy and then started to increaae again in the late pregnancy when the total catecholamines content became the highest level of all. This increase of catefholamines in late pregnancy was chiefly due to the increase of norepinephrine. These results suggest that the uterine motility may be related to the catecholamines content, especially norepinephrine content in the uterus. 3) Bilateral oophorectomy of rabbits results in a marked shrink of the uterus in size. The spontaneous motility of the uterine segment of these animals was very weak and irregular. Norepinephrine produced inhibitory effect, whereas epinephrine was stimulatory or inhibitory effect on the uterine segment. The total catecholamines tontent in whole uterus was markedly reduced. The injection of estrogen into the oophorectornized rabbit increased the weight of uterus to approximately three times of that of oophorectornized animal. The apontaneous motility and the response to epinephrine and norepinephrine of the uterine segment were greatly enhanced. Both epinephrine and norepinephrine produced a marked stimulatory effects of the uterine motility. The uterine content of catecholamines, particularly epinephrine, was markedly increased. The injection of progesterone into the oophorectornized rabbit increaeed the weight of uterus to approximately 2.5 times of that of eophorectornized animal. The spontaneous motility of the uterine segment was weak and irregular. Epinephrine produced stimulatory effect at high concentrations but norepinephrine always prcdnced inhibitory effect on the uterine segment. The uterine content of catecholamines, particularly of norepinephrine, was markedly reduced. These results suggested that ovarian hormones play an important role not only on the growth and spontaneous norepinephrine of uterus but also on the catecholamines content and responee to epinephrine and norepinephrine of the uterus. 4) The intraperitoneal injection of reserpine(3 mg/kg) into the non-pregnant, pregnant and oophorectornieed rabbits markedly decreased the uterine content of catecholamines, particularly of the norepinephrine. The stimulatory response to epinephrine and. norepinephrine of the uterine segment of these reserpinized ratbits was markedly reduced whereas the inhibitory response to these catecholamines was enhanced. This finding further support the close relationship between the uterine catecholamines content and uterine response to epineptrire and norepinephrine. 5) In the human uterus, the concentration of epinephrine was actrally greater than that of norepinephrine and it was significantly greater during the proliferative phase of the menstrtal cycle. In the human pregnant uterus, the concentrations of toth epinephrine and ncrefinephrine were markedly reduced and showed about 45 percent rednction after 6-8 weeks of ectopic Pregnancy. At full term ana during labor, the concentrations of epinephrine and norepinephrine at placental sites were less than those found in the non-pregnant group. Of interest was the finding that the norepinephrine concentration of uterus from toxemic patients was two and half times higher than that of lower uterine segment of the nontoxemic pregnant individuals. Also the epinephrine concentraticn was slightly increaeed.

• Clinical and Experimental Reproductive Medicine
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• v.27 no.4
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• pp.353-357
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• 2000

Objective: Extrauterine formation of decidua of stromal cells has been well described, particularly in the cervix and ovary. The apparent hormonal mechanisn of this phenomenon suggestes a relationship to endometriosis. Whether formation of ectopic decidua represents a marked progestational response of endometriosis or an independent peritoneal-stromal reaction to pregnancy is unclear. This study was designed to determine the prevalence of deciduosis in the patients whose fertility were proven. Design: Prospective study of patients who had undergone cesarean delivery without history of endometriosis. Materials and Methods: The study was performed in 179 full tenn pregnant women. During the cesarean section, the pelvic organs were thoroughly investigated and the biopsies were collected at the lesions suspicious endometriosis. And then microscopic examination of removed tissues were done. Results: Of the 179 patients who underwent cesarean delivery, 48 women (26.8%) had the lesions suspicious endometriosis such as adhesion, pigmented spots. The ovary was the most frequently ocurred site (79.2%). Microscopically, decidual cells were observed in 34 cases (70.8%) of 48 biopsed patients. Conclusion: Endometriosis has been known to be associated with subfertility. Our observations found the prevalence of deciduosis was 19.0% (34/179) in tenn pregnant women whose fertilites were proven. We suggests that the deciduosis maya manifestation of endometriosis during pregnancy. However, further follow up study should be done to confirm this clinicopathologic process.

• Journal of Yeungnam Medical Science
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• v.22 no.1
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• pp.43-51
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• 2005

Background: To examine the ultrasonographic and magnetic resonance (MRI) imaging findings of a cervical mass type cervical pregnancy. Materials and Methods: The ultrasonographic and MRI findings of 5 patients pathologically confirmed as having a cervical pregnancy were analyzed retrospectively. On ultrasonography, the size and echo pattern of the uterine cervix, the shape and echo pattern of the lesion, the degree and the pattern of blood flow on the color Doppler study and the spectral Doppler pattern were analyzed. The shape, signal intensity, and degree and pattern of enhancement of the lesion were evaluated on MRI. Results: The uterine cervix was enlarged and the size of the lesion was 6.1 to 7.1 (average, 6.5) cm. The endocervical canal was irregularly dilated and showed heterogeneous echogenicity in all 5 cases. Four of the 5 lesions were heterogeneously hyper- or mixed echoic and remaining one was relatively homogeneous echogenic. Doppler ultrasonography revealed an increased vascularity of the peritrophoblastic flow pattern. In all 4 cases where MRI performed, the lesion was irregular in shape and the margin was not sharply demarcated. The T2-weighed image showed that the lesions were mixed signal intensity. Three of the 4 lesions contained high signal intensity nodular portions and a low signal intensity rim was observed along the margin of the nodular portions. The T1-weighted image revealed multiple signal voids along the periphery of the lesions and high signal intensity portions as a result of hemorrhage were noted. The dynamic enhanced study showed that the high signal intensity portions on the T2-weighted image were strongly enhanced similar to the vessels on the early phase and the contrast enhancement gradually decreased with time. Conclusion: A cervical mass type cervical pregnancy can be correctly diagnosed using the patient's clinical symptom, the elevation in the serum ${\beta}$-HCG level, and characteristic ultrasonographic and MRI findings.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.202-206
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• 2023

Cesarean scar pregnancy (CSP) is a rare complication that occurs in less than 1% of ectopic pregnancies, and uterine didelphys is one of the rarest uterine forms. We report a successful laparoscopic excision and repair of CSP in a woman with uterine didelphys and a double vagina. A 34-year-old gravida one, para one woman with a history of low transverse cesarean section presented to our hospital with a suspected CSP. She was confirmed to have uterine didelphys with a double vagina during an infertility examination 7 years earlier. Magnetic resonance imaging showed a 2.5-cm gestational sac-like cystic lesion in the lower segment of the right uterus at the cesarean scar. We decided to perform a laparoscopic approach after informing the patient of the surgical procedure. The lower segment of the previous cesarean site was excised with monopolar diathermy to minimize bleeding. We identified the gestational sac in the lower segment of the right uterus, which was evacuated using spoon forceps. The myometrium and serosa of the uterus were sutured layer-by-layer using synthetic absorbable sutures. No remnant gestational tissue was visible on follow-up ultrasonography one month after the surgery. This laparoscopic approach to CSP in a woman with uterine didelphys is an effective and safe method of treatment. In women with uterine anomalies, it is important to confirm the exact location of the gestational sac by preoperative imaging for successful surgery.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.131-136
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• 1999

자궁경관 임신은 최근에 인공유산의 증가와 인공 보조 생식술(assisted reproductive technology) 등에 의하여 증가되는 양상을 보인다. 과거에는 자궁경관 임신은 대량의 무통성 질출혈로 진단을 내리고 치료 방법은 천자궁적출술이 유일한 수단이었으나, 지금은 질식 초음파의 개발로 자궁경관 임신을 조기에 진단하고 자궁 보존적 방법으로 치료하여 차후 임신을 기대할 수 있게 되었다. 그 치료 방법 중 하나로 Methotrexate(MTX)를 주사하여 성공적으로 치유된 많은 보고들이 있었다. 본 저자들은 임신 8주에 자궁경관 임신으로 진단된 환자에서 전신적 MTX 투여와 복식 초음파 관찰 하에 양막강내 MTX 투여 병합 요법으로 치료한 1례를 보고하고 치료과정에서 자궁경부 병변의 지연 관해에 대해서 문헌 고찰과 함께 보고하는 바이다.

• The Journal of Korean Obstetrics and Gynecology
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• v.15 no.4
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• pp.218-227
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• 2002

Pelvic Inflammatory Disease(PID) is a spectrum of inflammatory disorders of the female genital tract involving at least the endrometrium and may include the fallopian tubes, ovaries, and pelvic cavity. Women with PID acutely experience pain and are at risk for sepsis; however, the long-term complications such as chronic pelvic pain, organic changes like chronic salpingitis, adhesions, etc., and the significant increases in ectopic pregnancy and infertility are more important and hard to control. This study is about one patient who has chronic PID with inflammatory pelvic mass. The patient was treated with retention enema therapy which use herbs effective for reducing inflammation, resolution abdominal mass, promoting blood circulation. Also, treated with herbal medication of Danchisoyosan(丹梔逍遙散) and Moxibution at Zhongwan(中脘), Guanyuan(關元). After total treatment for three months, the patient's symptoms are improved and the size of inflammatory pelvic mass is reduced. This results indicates that the combination treatment, especially the retention enema therapy is effective on reducing symptoms of PID and the size of secondary inflammatory organic changes.

• Korean Journal of Clinical Pharmacy
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• v.30 no.1
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• pp.19-30
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• 2020

Objective: To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. Methods: We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability. Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. Results: Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. Conclusion: BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.

• Clinical and Experimental Reproductive Medicine
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• v.18 no.2
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• pp.209-214
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• 1991

Endosalpingiosis is defined as the ectopic location of tubal epithelium. The term is purely descriptive and does not necessarily imply either the direct origin from tubal mucosa or the similarity of function. This study was performed to evaluate the clinical and pathologic characteristics of endosalpingiosis in the patients with endosalpingiosis proven by pathologic investigation. The medical histories and pathologic reports of 22 endosalpingiosis patients who received the laparotomy at Seoul National University Hospital from August, 1982 to December, 1990 were reviewed. The results were as follows: 1. Age distribution was from 26 to 46 years with the mean age of 34.0 years. 2. Twelve(54.6%) patients were nulligravida and the chief complaint of these patients was infertility(45.5%). 3. Six (27.3%) patients had the previous laparoscopic tubal sterilization by electrocautery or ring application. 4. Four (18.2%) patients had previous history of tubal pregnancy. 5. The most prevalent location of endosalpingiosis was the proximal segment of the salpinx, and the length of the proximal stump from the lesion was less than 1cm in 16(72.7%) patients.

• CELLMED
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• v.13 no.6
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• pp.4.1-4.10
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• 2023

Background and objective: Cervicitis are an inflammatory condition of the cervix. This may be acute, chronic, active & specific or non-specific, which may cause various sign & symptoms. Abnormal vaginal discharge, lower abdominal pain, lower backache, post coital bleeding. If not treated timely it causes various complications viz PID, infertility, endometritis, ectopic pregnancy etc. Hence it has been decided to conduct a clinical trial for its management. Method: This study was an open observational study. The entire patients were allocated by considering the criteria of inclusion & exclusion. Marhame dakhilyun with roghane sausan is given 10 mg as ḥamūl at bed time, after menses for 21 days. All the patients were assessed by primary outcome of abnormal vaginal discharge, lower abdominal pain, lower backache, post coital bleeding & secondary outcomes of vaginal symptoms scale score (VSS) which score the vaginal discharge with QOL in cervicitis patients and vaginal analogue scale (VAS) for pain. Result: In this present study, marked improvement is observed in cervicitis. The mean ± SD of vaginal discharge before & after treatment is 2.57±0.050, 0.33±0.48 respectively which is highly significant with p value of<0.0001^**. VSS score before & after treatment is 21.27±6.12, 7.47±2.48 respectively with p<0.0001^** which is highly significant. VAS score used for LAB & LPA before & after treatment is 6.63±1.09, 1.90±1.29 respectively with p<0.0001^** which is highly significant. Interpretation & Conclusion: The study revealed that the formulation has been found effective in healing congestion, hypertrophied of the cervix and discharge and relieving the others associated symptoms of cervicitis. It is useful and provided immediate and effective treatment for cervicitis. Hence, the trial drug can be recommended for its management.

• Clinical and Experimental Reproductive Medicine
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• v.36 no.4
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• pp.275-281
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• 2009

Objective: This study was performed to evaluate the effect of oxytocin antagonist on the outcome of IVF/ICSI cycles in infertile patients with repeated failure of IVF/ICSI treatment. Method: Forty patients who had experienced two or more failures of IVF/ICSI treatment without low ovarian reserve, were recruited for this prospective randomized study. All patients received controlled ovarian stimulation (COS) using GnRH antagonist multidose protocol (MDP). For the intervention group, intravenous administration of atosiban (mixed vasopressin $V_{1A}$/oxytocin antagonist) started with a bolus dose 6.75 mg one hour before embryo transfer (ET) and continued at an infusion rate of 18 mg/hour. After ET, administered atosiban was reduced to 6 mg/hour and continued for 2 hours. The main efficacy endpoints were clinical pregnancy rate and implantation rate. Results: Patients' characteristics were comparable in the intervention and control groups. COS parameters and IVF results were also similar. The number of uterine contractions for 3 minutes measured just before ET was significantly lower in the intervention group than control group ($3.5{\pm}1.4$ vs $8.7{\pm}2.2$, p<0.001). While there was no statistically significant difference in the clinical pregnancy rate between control group and intervention group (20.0% and 40.0%, p=0.168), the implantation rate was significantly higher in the intervention group, with 16.9% (11/65) compared with 6.0% (4/67) in the control group (p=0.047). There were no differences in ectopic pregnancy rate and miscarriage rate between the two groups. Conclusion: This study demonstrates that administration of oxytocin antagonist during ET can improve the implantation rate probably by decreasing the frequency of uterine contractions in infertile patients undergoing IVF/ICSI treatment.