• Clinical and Experimental Reproductive Medicine
• /
• 제32권1호
• /
• pp.17-26
• /
• 2005

Objective: Preimplantation genetic diagnosis (PGD) is reserved for couples with a risk of transmitting a serious and incurable disease, and hence avoids the undesirable therapeutic abortion. In this study, we evaluated the efficacy of PGD for Duchenne muscular dystrophy (DMD) cases by the fluorescent PCR with polymorphic linked markers and the conventional duplex-nested PCR methods. Methods: Biopsy of one or two blastomeres was done from the embryos fertilized by ICSI on the third day after fertilization. We performed two cases of PGD-DMD by the duplex-nested PCR for the causative mutation loci and the SRY gene on Y chromosome. The triplex fluorescent PCR for the mutation loci, the SRY gene and the polymorphic microsatellite marker on X chromosome was applied for two cases of PGD-DMD. Results: By the duplex-nested PCR, successful diagnosis rate was 95.5% (21/22), but we could not discriminate the female embryos whether normal or carrier in this X-linked recessive disease. However, the triplex fluorescent PCR method showed 100% (27/27) of successful diagnosis rate, and all female embryos (n=17) were distinguished normal (n=10) from carrier (n=7) embryos. Unaffected and normal embryos were transferred into mother's uterus after diagnosis. A healthy normal male was achieved after PGD with the duplex-nested PCR method and a twin, a male and a female, were delivered with triplex fluorescent PCR method. The normality of dystrophin gene was confirmed by amniocentesis and postnatal genetic analysis in all offsprings. Conclusion: The fluorescent PCR with polymorphic marker might be useful in improving the specificity and reliability of PGD for single gene disorders.

• 한국의료질향상학회지
• /
• 제7권1호
• /
• pp.32-45
• /
• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• Asian Pacific Journal of Cancer Prevention
• /
• 제17권2호
• /
• pp.799-805
• /
• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권15호
• /
• pp.6705-6709
• /
• 2015

Background: Venous thromboembolisms (VTEs) constitute a group of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). They regarded as the second leading cause of death in cancer patients and several studies have confirmed that VTEs have a negative impact on survival and recurrent rate in both ovarian and endometrial cancer cases. The incidence of VTEs differs worldwide and depends on several risk factors including race, underlying disease, lifestyle, body weight, BMI and genetic risk factors. There is heterogeneity of DVT rates between Asian and Western countries. This study was conducted in order to evaluate the character and incidence of VTEs in gynecologic oncology patients in King Chulalongkorn Memorial Hospital over a 10 year period. Materials and Methods: A retrospective chart review was performed with VTEs defined as objective diagnosis of acute DVT or PE with typical symptoms and signs. Diagnoses were approved byan internist and/or confirmed with imaging studies. Data from both outpatient and inpatient sessions of the affected cases from January 2004 to December 2013 were extracted. General characteristics of the patients were collected with details of the diseases, types of cancer, stage, date of diagnosis of cancer, operative data, treatment outcome, progression free survival and overall survival. Results: Thirty cases of VTEs were identified in a total 2,316 gynecologic oncology cases. The incidence of symptomatic VTEs in total gynecologic oncology patients in our institution is 1.295%. The incidence of VTEs in ovarian cancer patients in our institution was 5.9%. Duration for VTE detection ranged from 13 months before diagnosis of cancer to 33 months after diagnosis of cancer. Most of the VTE cases were detected in ovarian cancer patients (60%). The most common cell type was adenocarcinoma (moderately to poorly differentiated) which accounted for 26.7% of the cases. The second most common cell type was clear cell carcinoma with 23.3% of the cases. Thirty percent of VTE cases developed before cancer was diagnosed, 20% were diagnosed at the same time as cancer detection and fifty percent developed after cancer was diagnosed. Median disease free survival of the gynecologic oncology patients with VTE was 7.5 months. Median overall survival (OS) was 12 months. Median progession free survivals of DVT and PE groups were 11.5 and 5.5 months, respectively. OS of DVT and PE was 12.0 and 11.5 months respectively. Conclusions: The incidence of VTE in Asian countries is believed to be lower than in European or Western countries. From our retrospective review, the incidence of VTEs in all types of gynecologic oncology was 1.295%, much lower than reported in the West. The reason for the lower incidence may genetic differences. Another factor is that VTE in this review was symptomatic, which is less than asymptomatic VTE. More than half of VTEs in this study developed in ovarian cancer patients. The results are compatible with earlier reports that among gynecologic malignancies, the incidence of VTE is highest in ovarian cancer.

• Clinical and Experimental Reproductive Medicine
• /
• 제27권2호
• /
• pp.165-172
• /
• 2000

Objective: In vitro fertilization (IVF) and a prolonging the time of culture may be helpful in establishing a viable pregnancy through a selection effect. Some embryos do not develop beyond the 4-cell stage and some may not develop to the blastocyst stage. We have evaluated the safety of SET and the outcomes of pregnancy. Methods: Sperms were treated with Ham's F-10 supplemented with 10% human follicular fluid (hFF). oocytes or fertilized oocytes were cultured in Dulbecco's Modified Eagle Medium (DMEM) with 10% or 20% hFF respectively. Up to five oocytes were inseminated with approximately 200,000 sperm cells/2 ml in each well. Fertilization was examined in the following morning and fertilized oocytes were co-cultured until embryo transfer. Vero cells for co-culture were prepared in Tissue Culture Medium - 199 (TCM-199) with 10% fetal bovine serum. At the two to four cell and blastocyst on day 2 and day 5, embryo and blstocyst grading were evaluated. Pregnancy rate was determined after transfer of human embryos at the two to four cell stage on day 2 (Group I) or subsequent transfer of embryos on day 2 and at the blastocyst stage on day 5 (Group II). For statistical analysis, Student's t-test and Chi-square (${\chi}^2$_test) were used. Results were considered statistically significant when p value was less than 0.05. Results: No differences was found in the fertilization between Group I (81.0%, 98/121) and Group II (81.8%, 180/220). In case of cleavage rate, no difference was found in Group I (95.9%, 94/98) and Group II (97.8%, 174/178). However, the rate of-clinical pregnancy was significantly higher (p=0.014) in Group II (66.7%, 12/18) than in Group I (26.3%, 5/19). Conclusion: The results of this study showed that SET is safe and effective, and significantly increases the pregnancy rate.

• Clinical and Experimental Reproductive Medicine
• /
• 제26권3호
• /
• pp.483-490
• /
• 1999

Objectives: Polycystic ovary syndrome (PCOS) has the feature of excessive LH, hyperandrogenism and disturbance of folliculogenesis. Also, insulin, IGF-I and IGFBP-l are involved in the pathogenesis of PCOS. Various surgical and medical therapies have been used and the action mechanisms are related to the endocrine effect. Laparoscopic ovarian electrocautery or laser vaporization is effective in the restoration of ovulation and normal menstrual cycle with minimal invasive procedure especially in the patients resistant to medical therapy. Clomiphen citrate (CC) is used for the ovulation induction in pcas and the resistance is known to be related to insulin, IGF-I, IGFBP-l levels. This study was performed to evaluate the effect of the laparoscopic laser vaporization on the levels of LH, FSH, testosterone, IGF-I and IGFBP-l and on the ovarian response to clomiphen citrate in patients with CC-resistant PCOS. Materials and Methods: The fasting basal serum LH, FSH, testosterone, IGF-I and IGFBP-l level were measured in 10 PCOS patients with CC-resistance and 7 normal controls with regular menstrual cycle. In PCOS, after laparoscopic $CO_2$ laser vaporization, endocrine levels were measured in 1 week interval for 4 weeks and then compared with preoperative levels. Results: In PCOS group, mean serum LH/FSH ratio, testosterone, IGF-I levels were higher and IGFBP-l level was lower than control. LH/FSH ratio decreased from $2.51{\pm}0.67$ to $1.7{\pm}0.6$ (p<0.05) in 2 weeks, to $0.56{\pm}0.2$ (p<0.01) in 3 weeks and to $1.41{\pm}0.3$ (p<0.01) in 4 weeks after operation. Testosterone level decreased from $1.51{\pm}0.82ng/ml$ to $0.65{\pm}0.34ng/ml$ (p<0.05) in 2 weeks, to $0.56{\pm}0.67ng/ml $(p<0.01) in 3 weeks after operation. IGF-I level also decreased from $436{\pm}47.5{\mu}g/l$ to $187{\pm}38{\mu}g/l$ (p<0.0l) in 1 week, to $167{\pm}42{\mu}g/l$ (p<0.01) in 2 weeks, $179{\pm}55{\mu}g/l$ (p<0.01) in 3 weeks and to $120{\pm}43{\mu}g/l$ (p<0.01) in 4 weeks after operation. IGFBP-l level showed no significant change. In 8 of 10 PCOS patients, ovulation was induced with low dose clomiphen citrate. Conclusion: Laparoscopic $CO_2$ laser vaporization restores normal menstrual cycle and ovulation through endocrine effect of decreasing LH/FSH ratio, testosterone and IGF-I level and increases the response to CC. Therefore it is useful for restoration of normal menstruation and induction of ovulation in CC resistant PCOS patients.

• Clinical and Experimental Reproductive Medicine
• /
• 제14권1호
• /
• pp.19-28
• /
• 1987

35 patients of normal reproductive age group (22-37 yrs) were selected for ovulation induction using $Clomid^{(R)}$ and HMG. Correlation between canalization of cervical mucus and estradiol level in plasma. morphological ovarian follicular change by ultrasonogram, Ferning and Spinnbarkeit were studied in the induced ovulatory menstrual cycles. By retrospective analysis, the results were following; 1. Canalization appeared on the eighth day of the menstrual cycle in $Clomid^{(R)}$ group, and seventh day of HMG group. And the number of the channels increased gradually until the ovulation time. 2. The mean number of channels increased from 12${\pm}$12 in $Clomid^{(R)}$ group, 19${\pm}$14 in HMG group (Day-6) to a maximum of 46${\pm}$22 in $Clomid^{(R)}$ group (Day-1). 3. The maximum plasma estradiol(E2) level was 812${\pm}$722pg/ml in $Clomid^{(R)}$ group (Day-1), 1792${\pm}$504 pg/ml in HMG group (Day-1), and there was a good statistical correlation between the number of channels and the plasma E2 level. 4. The maximal follicular diameter was 19.4${\pm}$6.7 mm in $Clomid^{(R)}$ Group (Day-1) 19.3${\pm}$4.6mm in HMG group (Day-1) and after than decreased. There was a good statistical correlation between the number of channels and the follicular diameter. 5. When grade of ferning was I, the number of channels were 19.4${\pm}$6.7 in $Clomid^{(R)}$ group, 38${\pm}$26 in HMG group. When grade of ferning was III, the number of channels were 54${\pm}$30 in $Clomid^{(R)}$ group, 71${\pm}$36 in HMG group. 6. The maximum score of Spinnbarkeit was 2.6${\pm}$0.5 in Clomid group (Day-0), 2.6${\pm}$0.5 in HMG group (Day-2). In conclusion, the phenomenon of cervical mucus canalization showed the value of the clinical use as an ovulatin marker.

• Clinical and Experimental Reproductive Medicine
• /
• 제44권3호
• /
• pp.152-158
• /
• 2017

Objective: To identify the associations between polymorphisms of the 3'-untranslated region (UTR) of methylenetetrahydrofolate reductase (MTHFR) gene, which codes for an important regulatory enzyme primarily involved in folate metabolism, and idiopathic recurrent pregnancy loss (RPL) in Korean women. Methods: The study population comprised 369 RPL patients and 228 controls. MTHFR 2572C > A, 4869C > G, 5488C > T, and 6685T > C 3'-UTR polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis or by TaqMan allelic discrimination assays. Natural killer cell proportions were determined by flow cytometry. Results: The MTHFR 2572-5488-6685 (A-C-T) haplotype had an adjusted odds ratio of 0.420 (95% confidence interval, 0.178-0.994; p= 0.048) for RPL. Analysis of variance revealed that MTHFR 4869C > G was associated with altered $CD56^+$ natural killer cell percentages (CC, $17.91%{\pm}8.04%$; CG, $12.67%{\pm}4.64%$; p= 0.024) and folate levels (CC, $12.01{\pm}7.18mg/mL$; CG, $22.15{\pm}26.25mg/mL$; p= 0.006). Conclusion: Variants in the 3'-UTR of MTHFR are potential biomarkers for RPL. However, these results should be validated in additional studies of ethnically diverse groups of patients.

• 대한한방부인과학회지
• /
• 제20권2호
• /
• pp.164-175
• /
• 2007

Purpose: The purpose of this study was to investigate the relationships between the herbal medicines used for women in puerperium on postpartum care, Kami-Saenghwatang(SHT) and Kami-Bohertang(BHT) and postpartum body composition change. We also examined the influence of gestational age, the number of parity and the route of delivery for gestational weight gain and postpartum weight loss. Methods: 239 women followed by postpartum care center. Variety factor s were conformed and then checked body composition analysis. 8 weeks later, we followed up body composition of 36 women among the former checked. and additionally asked the body weight of another 42 former checked women by telephone call. Results: $Mean{\pm}S.D$(standard deviation) of pre-pregnancy weight is $55.22{\pm}8.98kg$, $Mean{\pm}S.D$ of gestational maximun weight is $69.26{\pm}9.77kg$, $Mean{\pm}S.D$ of weight loss in postpartum 8 weeks(means sub-tract postpartum 1 week weight from postpartum 8 week weight) is $57.86{\pm}8.60kg$. The number of parities had corrrelation with gestational weight gain. Age, number of parities and route of delive were not significantly correlated with postpartum weight loss during 8 weeks after delivery, and also it was not correlated with body water mass, body fat mass, body mass index and body weight on postpartum 8 weeks whether they treated with SHT and BHT. conclusion: It was not correlated with body water mass, body fat mass, body mass index and body weight on 8 weeks postpartum whether they treated with SHT and BHT.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권9호
• /
• pp.3861-3866
• /
• 2015

Background: The aim of this study was to analyze the patterns of relapse and survival outcomes in Northern Thai women with recurrent endometrial cancer (EC). Materials and Methods: Medical records were abstracted from EC patients who underwent primary surgery from 1999 to 2012. Data on clinicopathologic variables, sites of first recurrence, time to relapse of disease, and overall survival (OS) was analyzed. Associations between the clinicopathological variables and the rates of disease recurrence were determined. Results: Among 1,204 reviewed records, 42 eligible patients were identified with recurrent disease. The median age was 55 years and the median follow-up time was 26.0 months. The median times to recurrence (TTR) after completion of the initial treatment in the group of local relapse (LR) and distant/combined sites of recurrence (DCSR) was 6.6 (95% CI=4.6 to 8.6 months) and 16.9 months (95% CI=5.6 to 28.2 months), respectively (p=0.36). The 2-year survival and 3-year survival probability in the group of LR was 54.2% (95% CI=27.2 to 81.3%) and 34.7% (95% CI=9.2 to 60.2%), compared to 50.4% (95% CI=41.1 to 59.7%) and 42.1% (95%CI= 24.1 to 60.1%) for those with DCSR. Distant recurrence was the most frequent pattern of relapse. Overall survival was not significantly different in patients with local relapse when compared to those with DCSR (p=0.69). Conclusions: Patients with recurrence of EC after primary treatment had a worse prognosis and clinical aggressiveness. LR and DCSR occurred most during the first three years. The common sites of relapses were vaginal cuff, pelvis, and lungs. No significant clinicopathological predictor for survival outcomes was identified.