A Case of Endometriosis at the Site of Episiotomy Scar / 대한산부인과학회잡지

Endometriosis at the site of episiotomy scar following vaginal delivery is rare condition among the extrapelvic endometriosis implantation. We have experienced a case of episiotomy scar endometriosis. The precise anatomical location of the endometriotic lesion is confirmed using preoperative anal endosonogarphy. We believe anal endosonography to be essential when history, digital examination, and proctoscopy are not conclusive in the differential diagnosis of perianal pain or mass. The treatment of choice is complete surgical excision of the lesion and the surgical excision usually obtain permanent cure. We report a case of endometriosis at the site of episiotomy scar.

A Case of Asymmetric Septal Hypertrophy Combined with Conn's Syndrome

We report a case of a 44 year old femele with unilateral aldosterone-proudcing adrenal adenoma characterized by hypertension, plasma aldosterone excess, and low plasma renin, commonly but not invariably with hypokalemia. She also had asymmetric septal hypertrophy of left ventricle established with two-dimensional echocardiography. The electrocardiogram showed inverted T wave and prominent U wave with high QRS voltage on precordial leads. In the case of this patient, we are not sure whether asymmetric septal hypertrophy was caused by secondary hypertension and chronic aldosterone excess of primary aldosteronism, or hypertrophic cardiomyopathy per se, so further long=term follow-up is required to determine it. Following the successful unilateral adrenalectomy, however, the systemic pressure fell down to the normal level and electrolyte abnormalities were corrected immediaterly within a few days and the modest regression in septal hypertrophy was noted in one year, suggesting that the promary aldosteronism contributes to the development or porgression of asymmetric septal hepertrophy.

A Case of Pacemaker Syndrome

Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.