Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review

Endometriosis is a chronic inflammatory condition that affects fertility and could be toxic to the ovary. Endometrioma per se and surgical interventions for endometrioma significantly reduce the ovarian reserve. Therefore, to prepare for surgical intervention for endometrioma, the high-risk group with decreased ovarian reserve must be considered. There is no evidence to support the use of surgical intervention before in vitro fertilization (IVF) to improve the reproductive outcomes of subsequent IVF in infertile women with advanced-stage endometriosis or endometrioma. As surgical treatment has few benefits, IVF could be recommended immediately for aiding conception in these women. However, the reproductive prognosis of IVF may be worse in the more advanced stages of endometriosis. When dysmenorrhea is severe or when cancer is suspected, surgery prior to IVF may be necessary and justified. When the size of the endometrioma is very large, surgery could be required prior to IVF to facilitate access to follicles during oocyte retrieval or to improve the ovarian response to controlled ovarian stimulation. Prolonged pituitary downregulation in women with surgically diagnosed endometriosis may be helpful to increase the clinical pregnancy rate in subsequent IVF cycles. The purpose of this paper was to review the efficiency and clinical application of the surgical intervention and IVF for infertile women with advanced-stage endometriosis or endometrioma.

Chronic endometritis and infertility / 대한생식의학회지

Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.

The meaning of anti-Müllerian hormone levels in patients at a high risk of poor ovarian response / 대한생식의학회지

Measurements of ovarian reserve play an important role in predicting the clinical results of assisted reproductive technology (ART). The ideal markers of ovarian reserve for clinical applications should have high specificity in order to determine genuine poor responders. Basal follicle-stimulating hormone levels, antral follicle count, and serum anti-Müllerian hormone (AMH) levels have been suggested as ovarian reserve tests that may fulfill this requirement, with serum AMH levels being the most promising parameter. Serum AMH levels have been suggested to be a predictor of clinical pregnancy in ART for older women, who are at a high risk for decreased ovarian response. We reviewed the prognostic significance of ovarian reserve tests for patients undergoing ART treatment, with a particular focus on the significance of serum AMH levels in patients at a high risk of poor ovarian response.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

PURPOSE: To analyze the results of surgical treatment for pathological fractures at the proximal femur. MATERIALS AND METHODS: Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. RESULTS: The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. CONCLUSION: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

PURPOSE: To analyze the results of surgical treatment for pathological fractures at the proximal femur. MATERIALS AND METHODS: Nineteen patients with a pathological fracture were included. The mean age was 65.7 years old. The patients comprised 8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. Musculoskeletal Tumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. RESULTS: The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochanteric fractures and 11 cases of subtrochanteric fractures. Intramedullary nailing was performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. CONCLUSION: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Anti-Mullerian hormone levels as a predictor of clinical pregnancy in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer cycles in patients over 40 years of age / 대한생식의학회지

OBJECTIVE: The aim of the current study was to determine the predictive value of anti-Mullerian hormone (AMH) levels for pregnancy outcomes in patients over 40 years of age who underwent in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. METHODS: We retrospectively analyzed the medical records of 188 women aged 40 to 44 years who underwent IVF/ICSI-fresh ET cycles due to unexplained infertility in the fertility center of CHA Gangnam Medical Center. Patients were divided into group A, with AMH levels or =1.0 ng/mL (n=91). We compared the clinical pregnancy rate (CPR) in the two groups and performed logistic regression analysis to identify factors that had a significant effect on the CPR. RESULTS: The CPR was significantly lower in group A than group B (7.2% vs. 24.2%, p or =1.90 ng/mL than in the group with AMH levels <1.90 ng/mL (p<0.001). CONCLUSION: Our study showed that AMH levels were predictive of clinical pregnancy in infertility patients over 40 years of age. Further prospective studies should be conducted to validate the predictive capability of AMH levels for the outcome of clinical pregnancy.

The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia

OBJECTIVE: The goal of this study was to compare postoperative surgical site pain in gynecologic cancer patients who underwent elective extended lower midline laparotomy and managed their pain with either the ON-Q pain management system (surgical incision site pain relief system, ON-Q pump) or an intravenous patient-controlled analgesia pump (IV PCA). METHODS: Twenty gynecologic cancer patients who underwent elective extended lower midline laparotomy were divided into two groups. One group received a 72-hour continuous wound perfusion of the local anesthetic ropivacaine (0.5%, study group) into the supraperitoneal layer of the abdominal incision through the ON-Q pump. The other group received intravenous infusion pump of patient-controlled analgesia (fentanyl citrate 20 mg/mL . kg+ondansetron hydrochloride 16 mg/8 mL+normal saline). Postoperative pain was assessed immediately and at 6, 24, 48, 72, and 96 hours after surgery using the visual analogue scale. RESULTS: Postoperative surgical site pain scores at 24, 48, and 72 hours after surgery were lower in the ON-Q group than the IV PCA group. Pain scores at 24 hours and 48 hours after surgery were significantly different between the two groups (P=0.023, P<0.001). Overall painkiller administration was higher in the ON-Q group but this difference was not statistically significant (5.1 vs. 4.3, P=0.481). CONCLUSION: This study revealed that the ON-Q pain management system is a more effective approach than IV PCA for acute postoperative surgical site pain relief after extended lower midline laparotomy in gynecologic cancer patients.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Anterior Pelvic Plating and Sacroiliac Joint Fixation in Unstable Pelvic Ring Injuries

PURPOSE: To analyze the effectiveness of anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation in patients with unstable pelvic ring injuries. MATERIALS AND METHODS: Thirty-two patients were included with twenty-one males and eleven females. The mean age was 41 years (range, 19-76). The mean follow-up period was 51 months (range, 36-73). According to AO-OTA classification, there were 11 cases of B2 injuries, 8 cases of B3 injuries, 9 cases of C1 injuries, 2 cases of C2 injuries and 2 cases of C3 injuries. In the posterior lesions, there were 20 cases of sacral fractures and 12 cases of sacroiliac joint disruptions or dislocations. Anterior pelvic plating and subsequent percutaneous sacroiliac joint fixation were performed. RESULTS: The clinical results were 16 cases of excellent, 10 cases of good, 4 cases of moderate and 2 cases of poor functional results. The 2 cases out of 7 moderate reductions had poor functional results with residual neurologic symptoms. The radiological results were 16 cases of anatomic, 9 cases of nearly anatomic and 7 cases of moderate reduction. All patients were healed except 3 cases of nonunion at the pubic ramus. The complications encountered were 3 cases of screw loosening, 2 cases of anterior plate breakage and 1 case of postoperative infection. CONCLUSION: In patients with unstable pelvic ring injuries, anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation may be a useful surgical option. The radiological results and residual neurologic symptoms had effects on its functional results.

Physeal Growth Arrest Caused by Thromboembolism of the Right Femoral Artery in a Premature Infant / 대한정형외과학회잡지

The known causes of premature physeal growth arrest are trauma, infection, tumor, antibiotics, radiation and vascular insult. We report here on a premature, very low birth-weight infant who was complicated with premature physeal arrest of the proximal and distal tibial physis after severe limb ischemia due to thromboembolism of the right femoral artery. This case suggests that a severe ischemic state of the lower extremity might cause premature physeal arrest in premature infants.

Pap smear screening for small cell carcinoma of the uterine cervix: a case series and review of the literature / 부인종양

OBJECTIVE: Small cell carcinoma of the uterine cervix (SMCC) is extremely rare, and an aggressive disease that proliferates rapidly. It was often reported that the diagnostic accuracy of cytologic smears in diagnosing SMCC was low. This is a report of the Severance Hospital experience with the patients suffering from SMCC. METHODS: Twenty-seven patients with small cell carcinoma of the uterine cervix were diagnosed and treated at the Severance Hospital from November 1991 to January 2010. The data were analyzed retrospectively, based on the available charts and pathology reports. Various fields, such as chief complaints and symptoms present at first clinic visit, age, International Federation of Obstetrics and Gynecology (FIGO) clinical stage, treatment modality, the 5-year overall survival rate, and recurrence rate were investigated. RESULTS: Among the 27 patients diagnosed with small cell carcinoma of the uterine cervix, 18 of them (66.7%) presented with symptoms, including vaginal bleeding, at the first clinic visit, and the remaining 9 patients (33.3%) showed abnormal Pap smear screening in the process of their routine health check-up. The median age of the patients was 54 years (range, 24 to 77 years). FIGO stage IIB was the most common stage (11 of 27 patients). The 5-year overall survival rate of 21 patients, who could be followed up, was 57.2%. Six patients showed recurrence after remission, and the mean disease free interval of them was 9.2 months (range, 6 to 11 months). Abnormal Pap smear screening results of 9 patients was investigated, and the diagnostic accuracy of the cytologic findings was 22.2%. CONCLUSION: Our study was consistent with the concept that Pap smear screening might not be helpful in early diagnosis of SMCC considering its low diagnostic accuracy. Further large-scale multicenter prospective studies are definitely needed in order to produce abundant information about optimal therapy and diagnosis.

Antepartum Pituitary Necrosis Occurring In Pregnancy with Uncontrolled Gestational Diabetes Mellitus: A Case Report

Antepartum pituitary necrosis is a rare medical condition that has only been reported in pregnant women with type I diabetes attributable to diabetes-related vasculopathy and hypercoagulability. We present for the first time a case of antepartum pituitary necrosis occurring in an uncontrolled gestational diabetes mellitus (GDM) patient. The patient was a 32-yr-old woman at 33 weeks and 2 days of gestation. She suffered from severe headache, blurred vision, dizziness, and vomiting. Her baby was delivered by Cesarean section. The brain magnetic resonance images revealed pituitary necrosis. This suggests that pituitary gland necrosis may also complicate GDM pregnancy when glucose levels are uncontrolled.

A Case of the Complete Hydatidiform Mole with Two Coexisting Fetuses / 대한주산의학회잡지

Hydatidiform mole with a coexisting fetus is rare, but this condition has recently shown an increased incidence because of assisted reproduction technology. In most of the reported cases, termination at diagnosis was preferred due to poor fetal survival and maternal risk factors such as vaginal bleeding, preeclampsia, hyperthyroidism, potential of malignant change. However, considering the value of pregnancy by assisted reproduction technology, whether to continue or to terminate this condition is a dilemma. Based on currently available information, it seems that it is reasonable to allow the pregnancy to continue in the absence of maternal complications. We report on a case of the complete hydatidiform mole with two coexisting fetuses with a brief reviews of the literature.

The relationship of bacterial and Helicobacter infection to composition of bile acid in biliary tract diseases / 대한내과학회지

BACKGROUND: Bacterial and Helicobacter gene were commonly detected in diseased human bile, although the meaning of the presence of Helicobacter in biliary tract is still unclear. The aim of this study was to evaluate the changes of bile acid composition in bacterial and Helicobacter infected bile, and to determine whether Helicobacter pylori might grow in human bile or not. METHODS: Thirty bile samples were obtained by percutaneous transhepatic biliary drainage or gallbladder puncture during cholecystectomy. According to the polymerase chain reaction analysis using bacterial 16S rRNA and Helicobacter genus specific 16S rRNA primers, 3 groups were divided; Group I; no presence of any bacterial DNA, Group II; positive bacterial DNA only, Group III; positive bacterial and Helicobacter DNA. Bile acid analysis for deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) was performed by high performance liquid chromatography. And then Helicobacter pylori was tried to culture in broth mixed with human bile at a final bile concentration of 50%. RESULTS: The concentrations of DCA in group II and III were very low and significantly reduced compared to group I (p<0.01, respectively). The concentrations of LCA or UDCA were not shown any relationships between groups. Helicobacter pylori has grown actively in the broth mixed with human bile containing both of less than 0.1 gm/L of DCA and CDCA, compared to no growth in media mixed with human bile containing more than 3.0 gm/L of DCA and/or CDCA. CONCLUSION: DCA seems to have the strongest antibacterial effect. Helicobacter pylori is likely to grow in human bile containg very low concentrations of CDCA and DCA.

Macroscopic Classification and Histo-Pathologic Evaluation of Early Colorectal Cancer with Elevated Type / 대한소화기내시경학회지

BACKGROUNDS/AIMS: Early colorectal cancer is defined as carcinoma with invasion to mucosa or submucosa irrespective of involvement of lymph node. Gross morphology is divided into elevated and depressed type according to growth pattern. Until now, carcinomas with elevated type have been found more frequently than depressed type in Korea. It is necessary to classify the macroscopy of morphology and evaluate histo-pathologic findings of early colorectal cancers. METHODS: 33 patients (35 foci) with early colorectal cancers were analyzed, macroscopically and pathologically. Early colorectal carcinoma with mucosal invasion is 25 cases, and with submucosal invasion, 10. RESULTS: Macroscopic classification: Ip 12, Isp 6, Is 9, IIa 1, IIa IIc 4, Isp IIc 1, LST 2. Among them, Ip (34%) is most. Among cancers with mucosal invasion, Ip (36%) is common, and with submucosal invasion, Is (40%) is common. Most of early colorectal cancers with elevated type were accompanied with surrounding adenoma. It's ratio is 100% in early colorectal cancer with mucosal invasion, and 50% with submucosal invasion. CONCLUSIONS: Pedunculated type (Ip) is common in early colorectal cancer with elevated type. Surrounding adenoma was usually (85%) accompanied with those. It is suggested that early colorectal cancer with elevated type would be originated from adenoma.

Identification of Helicobacter in diseased human bile / 대한내과학회지

BACKGROUND: Several studies have been reported that the presence of Helicobacter DNA in human bile sample, although its pathological role is not clear. The purpose of this study was to evaluate the presence and identification of Helicobacter species in human bile samples obtained from patients with biliary tract diseases. METHODS: 58 bile samples (35 intrahepatic duct stones, 10 bile duct cancer, 13 pancreatic cancer) were obtained by percutaneous transhepatic biliary drainage (PTBD). DNA was isolated from bile sample. The primers were designed to amplify region of Helicobacter genus specific 16S rRNA. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was developed to differenciate the presence of H. pylori, H. bilis, H. rappini and H. muridarum. RESULTS: Forty-two of 58 (72.4%) bile samples obtained from patients with biliary tract disease showed positive PCR band for Helicobacter genus specific 16S rRNA. H. pylori was found in 83.3% of positive samples. Either H. bilis or H. rappini was in 16.7%. H. muridarum, however, was not detected. CONCLUSION: Helicobacter genus was detected in human bile samples obtained from patients with biliary tract diseases using PCR method, and the major species was H. pylori. In addition, RFLP technique was used successfully to identify Helicobacter species.

A Case of Cerebral Infarction Caused by Tumor Emboli from the Site of

Multiple cerebral infarction developed in a 36-year-old woman with adenocarcinoma of the right lung with direct cardiac invasion. Neurological examination and brain MRI showed findings of ordinary infarction. Transesophageal echocardiography showed left atrial pedunculated mass which was the potential source of embolism. We report a rare case who had such multiple spontaneous tumor emboli large enough to result in clinically detectable cerebral infarction.

Relationship between Vimentin Expression and Progression of Uterine Cervix Epithelial Neoplasms

Vimentin is an intermediate filament protein normally expressed in mesenchymal cells, but the evidence of the aberrant expression of vimentin in epithelial cancer cells suggests that the vimentin expression might be related to local invasiveness and metastatic potential. There have been a few previous studies on the vimentin expression in human cervical carcinogenesis using in vivo and in vitro models. We examined the immunohistochemical vimentin expression in various squamous epithelial neoplasms of the uterine cervix, including the cervical intraepithelial neoplasia group (n=25), the microinvasive squamous cell carcinoma group (n=15), the invasive squamous cell carcinoma group (n=15) and the metastatic squamous cell carcinoma group (n=8). Vimentin positivity was significantly higher in the invasive than in the intraepithelial group, and in the cases with lymph node metastasis than in those without metastasis, suggesting a relationship between the vimentin expression and progression of the uterine cervical epithelial tumors.

Bilateral Elastofibroma: Report of a case

Elastofibroma is a rare benign tumor-like condition manifesting as firm and spherical mass with poorly circumscribed margins of fibroelastic tissue, occuring in the subscapular region or the chest wall of elderly persons. It is not a true neoplasm but rather a reactive or degenerative process causing abnormal elastogenesis. It is unilateral in the majority of cases and the right side is affected more commonly than the left. We report a case of bilateral elastofibromas removed from both subscapular regions of a 73-year-old female farmer. She was presented with tender masses on the bilateral subscapular areas for seven years. Microscopically, it consisted of a mixture of intertwining broad eosinophilic collagen bundles and elastic fibers associated with a few fibroblasts and mature fat cells. The elastic fibers had a degenerated beaded appearance or were fragmented into serrated globules in a linear arrangement.