Abdominal Endometriosis Diagnosed by Fine Needle Aspiration Cytology: A Report of Two Cases / 대한세포병리학회지

The incidence of endometriosis in post-operative abdominal scars is rare. We describe two cases of abdominal endometriosis diagnosed by fine needle aspiration (FNA). Both patients presented with subcutaneous masses at previous cesarean section scars with cyclic symptoms of pain. The cytologic smears were cellular and comprised two distinct cell populations consisting of epithelial and stromal components. An epithelial component consisted of flat sheets of polygonal cells and the second stromal component showed crowded clusters of spindle cells or isolated single cells. Hemosiderin-laden macrophages were found in the background. FNA offers a safe and effective tool for diagnosis of abdominal wall endometriosis.

A Case of Diagnosis and Management of Unruptured Rudimentary Horn Pregnancy with the Use of Laparoscopy / 대한산부인과학회잡지

The incidence of pregnancy in a rudimentary uterine horn is very rare. We experienced a case of unruptured rudimentary uterine horn pregnancy in the first trimester. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudimentary uterine horn. We report our case with brief review of literatures.

Laparoscopic versus Laparotomic Management of Adnexal Tumor before Week 18 of Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the safety and benefit of laparoscopic surgery compared with laparotomy for the management of adnexal tumor during pregnancy. METHODS: We reviewed 54 cases of adnexal tumor during pregnancy which were managed surgically at Chonbuk National University Hospital between January 1996 and July 2002. Laparoscopy was performed in 17 patients. The remaining 37 patients had laparotomy. The medical records were reviewed retrospectively to confirm variable factors, such as gestational age, operating time, surgical methods, pathologic results, and pregnancy outcomes and complications. RESULTS: Mean gestational age at surgery was significantly different between two groups (85.2 vs 103.0 days). Operating time was not significantly different between two groups. Hospital stay (4.6 vs 7.0 days) was significantly shorter in the laparoscopy group than laparotomy group. No operative or postoperative maternal complications occured in the pregnant women who had laparoscopic surgery. Five preterm deliveries and one intrauterine fetal death occured in the laparotomy group. CONCLUSION: Comparing with laparotomy, laparoscopic surgery allows a shorter hospital stay, a reduced rate of postoperative complications and a maternal and fetal morbidity compared. Laparoscopic surgery appears to be safe and effective during pregnancy.

A Case of Heterotopic Pregnancy Following in vitro-fertilization / 대한산부인과학회잡지

Heterotopic pregnancy occurs when an intrauterine pregnancy co-exists with an ectopic pregnancy. It is a potentially fatal condition, rarely occuring in natural conception cycle. But its incidence is increased since the rise in PID, pelvic surgery, IUD, and advent of assisted reproductive technology involving use of superovulatory drugs and/or in vitro-fertilization. We present a case of intrauterine twin pregnancy and right tubal pregnancy following treatment with in vitro-fertilization. The right tubal pregnancy was diagnosed after rupturing at 6th gestational weeks, and resected via laparoscopy. And healthy twin babies were delivered without complication at 38th gestational week. So we report this case with a brief review of the literatures.

Determinants of Reproductive Outcome after Abdominal Myomectomy in Infertile Women / 대한산부인과학회잡지

OBJECTIVE: To determine the effect of myomectomy as a treatment for infertility and to define the factors that influence reproductive outcomes MATERIALS AND METHODS: During the period from January 1995 to December 2001, on 39 patients who suffered from infertility and habitual abortion underwent transabdominal myomectomy at the Department of Obstetrics and Gynecology in Chonbuk National University Hospital. RESULTS: Pregnancy occurred in 31 women. The mean age was 32.3 years. The pregnancy rates in women with or without associated factors in addition to myoma were 55.5% and 71.4%, respectively, and those in women with 2 years of infertility were 73.7% and 55%, respectively. In case of women with myoma on lateral side, pregnancy rate was 33.3%. Considering the size, women with a myoma, 30~50 mm in size had higher pregnancy rate (81.2%). The 24-month cumulative probability of conception was 91% in patients 35 years of age. CONCLUSION: Our results suggest a benefit of myomectomy in infertile patients. Factors affecting the pregnancy rate after myomectomy in theses patients are the age of the patient, the duration of infertility, the site of myoma, and the size of myoma <50 mm. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.

A Case of Successful Transarterial Embolization (TAE) in Huge Arteriovenous Malformation (AVM) of Uterus / 대한산부인과학회잡지

A case of Cessation of massive vaginal bleeding after TAE in giant Arteriovenous Malformation (AVM) of the Uterus. A 68-year old woman who had massive vaginal bleeding was diagnosed of AVM of uterus by ultrasonogram, CT, MRI, and angiography. In our case report, we tried transarterial embolization 2 times by spring coils and detachable balloons. She was treated successfully by TAE resulting in prompt cessation of life- threatened vaginal bleeding. Color and duplex doppler US is an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transarterial embolization is a safe and effective method of treating this disease.

Vaginal Removal of the Pedunculated Submucous Myoma: Twisting-off Method / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of the twisting-off method in transvaginal removal of the pedunculated submucous myoma. METHODS: After paracervical block and vaginal dressing with Povidone iodine, the myoma was grasped at its widest diameter and twisted to avulse it from its attatchment. Several kinds of grasping instruments, ie. kelley clamp, tenaculum, ring forcep, was used. If there was bleeding from its detachment site, vaginal gauze or tampon was inserted for bleeding control. RESULTS: The procedure was perfomed successfully on all 33 patients (100%). In most patients, bleeding was scanty in amount. But in one patient, emergency hysterectomy was performed because of massive uterine bleeding. The myoma varied greatly in size. Largest volume was 62.24 cm3, and mean volume was 13.79 cm3. Pathology revealed classic leiomyomas in most cases. Some showed endocervical polyp or endometrial polyp. Follow up examination was done, and its mean interval was eighteen weeks and no patient was recurred. CONCLUSION: The transvaginal removal of pedunculated submucous myoma utilizing grasping instruments may be an effective and safe procedure and the complication is minimal. Twisting-off method was may be a safe alternative to abdominal myomectomy and hysterectomy. Reproductive capacity can be preserved, also.

Neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the neonatal and maternal infectious morbidity between single and multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes. METHODS: One hundred seventy patients who delivered neonates between 28 and 34 weeks' gestation after preterm premature rupture of membranes from January 1992 to July 2000 were reviewed retrospectively. Patients were divided into 3 groups on the basis of the following betamethasone exposures: (1) none (control subjects), (2) betamethasone 4 mg IM, IV simultaneously and then 4 mg IV q 8 hours for 24 hours (single course) and (3) weekly administration after initial single course (multiple courses). All included patients received prophylactic antibiotics for group B streptococci. The statistical analyses were done using x2 test, Fisher's exact test and one way analysis of variance (ANOVA). Multiple logistic regression analysis was performed to determine the confounding effect of the multiple variables those were considered as risk factors for neonatal sepsis. RESULTS: This study included 67 patients in the control group, 60 patients in the single course group, and 43 patients in the multiple courses group. The latency (p=.0001) was significantly longer in the patients exposed to multiple course than the patients in the control group and those in the single course group. No significant difference was demonstrated in the incidence of neonatal sepsis (p=.881) and postpartum endometritis (p=.619) among the three groups. Neonatal sepsis was significantly associated with clinical chorioamnionitis (p=.022). CONCLUSION: According to our data, multiple courses of antenatal betamethasone treatment in patients with preterm premature rupture of membranes was not associated with the increased incidence of neonatal sepsis and postpartum endometritis.

Predictive factors for residual neoplasia after loop electrosurgical excisional procedure (LEEP) in the treatment of cervical intraepithelial neoplasia / 대한산부인과학회잡지

OBJECTIVE: The optimal management of cervical intraepithelial neoplasia (CIN) after loop electrosurgical excisional procedure (LEEP) remains controversial and reliable predictive factors of residual disease after LEEP have not been consistently identified. This study was performed to identify predictive factors for residual disease after LEEP in patients with CIN. METHODS: From June 1996 to May 2000, 166 patients who received subsequent hysterectomy after LEEP according to indication in Dept. of Obstet. and Gynecol. at Chonbuk National University Hospital. The age of patients, the severity of disease, the status of resection margin, and high-risk HPV infection were analyzed for predictive values of residual disease. The student t-test and chi-square test were used for statistical analysis. RESULTS: 1. The residual disease after hysterectomy was negative in 68.1% (113/166) and positive in 31.9% (53/166). 2. The mean age of patients with no residual disease was 45.7 years (range;27-67) and that of patients with residual disease was 49.7 years (range;32-67), showing significant difference (p=0.008). 3. Thirty-three out of 129 cases (25.6%) with negative resection margin and 20 out of 37 cases (54.1%) with positive resection margin in LEEP had residual disease, showing significant difference (p=0.001). 4. Residual disease after hysterectomy was more frequent in patients with more high grade lesions in LEEP, but there was no statistical significant difference (p>0.05). 5. There was no significant difference in the possibility of positive residual disease after hysterectomy between HPV-positive group and HPV-negative group (p=0.84). CONCLUSION: The negative resection margin in LEEP does not always guarantee that there is no residual disease. More aggressive treatment plan (wide conization or hysterectomy) should be considered in patients who has higher possibility of residual disease such as old age and positive resection margin in LEEP.