Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis.

A case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus / 대한산부인과학회지

Placental abruption is defined as the early separation a normal placenta from the wall of the uterus before delivery of the fetus. The incidence of it is known 1% of all pregnancies and perinatal mortality rates from abruption range from 20% to 40% in recent studies. The most common symptom is vaginal bleeding. The causes are associated with preeclampsia, other hypertensive disorders, and premature rupture of membranes. It is diagnosed by clinical symptom, sign, and ultrasonography. Recently we have experienced a case of placental abruption diagnosed at 31 weeks by ultrasonography in bicornuate uterus with a brief review of the literature.

A case of laparoscopic treatment of collision tumor: Huge serous cystadenoma and dermoid cyst arising in the same ovary / 대한산부인과학회지

Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue and is rare incidence involving ovary. Because of their incidence of occurrence, benign cystic teratomas often occur coincidentally with other abnormalities of the ovary. Most common histologic combination of collision tumor in the ovary is coexistence of teratoma with mucinous tumors. But its association with serous tumor has been noted rare and incidence is unknown. We have experienced a case laparoscopic treatment of a huge serous cystadenoma combined with ovarian benign cystic teratoma in right ovary, and report it with a brief review of literature.

A case of hemoperitoneum to spontaneous perforation of uterine leiomyoma with huge cystic degeneration / 대한산부인과학회지

Uterine leiomyoma is common benign tumor in reproductive age woman. And secondary degeneration of uterine leiomyoma can be occurred usually during midpregnancy and the puerperium. But, spontaneous perforation of uterine leiomyoma with cystic degeneration is very rare. We have experienced a case of spontaneous perforation of a huge cystic degenerative uterine leiomyoma associated with massive hemoperitoneum in a menopausal woman, and report it with a brief review of literature.

Acute renal failure associated with ureteral stone of the unilateral kidney and uterus didelphys with hemivaginal obstruction / 대한산부인과학회지

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.

A case of congenital agenesis of left ovary and salpinx diagnosed incidentally during laparoscopic treatment of right ovarian pregnancy / 대한산부인과학회지

Asymptomatic unilateral absence of a portion of a fallopian tube with or without adjacent ovarian agenesis is a very rare condition. The true incidence is unknown. Two etiologic causes are possible. Asymptomatic segmental torsion of the uterine tube and ovarian pedicle may occur for certain reasons during adulthood, in childhood, or even during the fetal stages. Consequently, torsion may give rise to necrosis and autoamputation. Alternatively, the absence of these organs may be congenital. Ovarian pregnancy is a rare form of ectopic pregnancy occurring in 0.5~1% of all ectopic pregnancies. Moreover, ovarian pregnancy in patient with congenital unilateral tubal and ovarian agenesis has not been reported. But, the presenting symptom is very similar and difficult to distinguish with other forms of ectopic pregnancy. Early detection is important role in preserving fertility to avoid the ablation of functional ovarian tissue. We report a case of congenital unilateral tubal and ovarian agenesis diagnosed during laparoscopic treatment of ovarian pregnancy.

Cornual pregnancy diagnosed at 9 weeks of atypical ultrasonographic findings / 대한산부인과학회지

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

The indications, effectiveness and complications of the selective arterial embolization in the management of obstetrical hemorrhage / 대한주산의학회잡지

PURPOSE:The objective of this study was to evaluate the indications, effectiveness and complications associated with uterine arterial embolization as an alternative treatment of obstetrical hemorrhage. METHODS:From January 2006 to December 2008, 25 patients who underwent angiographic embolization for the obstetrical hemorrhage that was not responsive to conventional treatments, like obstetric maneuvers and uterotonic drugs, were included in our study. All medical records were reviewed and detailed clinical data such as clinical status, underlying conditions, amount of transfusion, embolized arteries, hospital stay, the success rate and the complications were collected. RESULTS:We have experienced clinically successful embolization in 22 (88%) of 25 patients with obstetrical hemorrhage resulting from various causes. After embolization, the patients' vital signs were stabilized. The causes of hemorrhage were atony of uterus (n=10), myomectomy during cesarean section (n=6), abnormal placentation (n=5), arterio-venous malformation (n=3), and cervical pregnancy (n=1). The average amount of blood transfusion was 7.2 units (range; 0~39 units). The average length of the time for the procedure was 55 minutes (range: 25~96 minutes). The average duration of hospitalization was 5.5 days (range: 2~14 days). In 22 patients, menses resumed spontaneously after procedures. The main complications after embolization were numbness and pain on lower extremities (n=1), and hypomenorrhea (n=1). CONCLUSION:The atrerial embolization is one of the safe and effective procedures that offers patients an alternative to hysterectomy for the treatment of intractable postpartum hemorrhage.

A case of primary amelanotic melanoma of the vagina / 대한산부인과학회지

Primary malignant melanoma of the vagina is extremely rare, accounting for 3% of all primary malignant tumor of the vagina and 0.3~1% of all malignant melanomas in the female. The amelanotic melanoma of the vagina showing no melanin granules on histological examination is exceedingly rare, accounting for only about 10% of all melanoma of the vagina. The amelanotic melanoma of the vagina is often difficult to differentiate from non-epithelial malignant tumor because of the minimal number of melanin granules. We describe a case of primary amelanotic melanoma of the vagina, which was initially suspected to be a non-epithelial malignant tumor, especially malignant peripheral nerve sheath tumor (MPNST), but was correctly diagnosed by HMB-45 antibody and S-100 protein immunohistochemical staining. So we present this case with a brief review of literature.

A case of treatment of peritoneal trophoblastic tissue implants after laparoscopic salpingectomy / 대한산부인과학회지

The incidence of ectopic pregnancy has increased considerably a decade. And treatment has changed from salpingectomy by laparotomy to conservative laparoscopic surgery or medical treatment. This procedure has many advantages, but there are also disadvantages with the conservative approach and several studies have reported a higher incidence of residual trophoblastic tissue remaining in the tube after treatment. Postoperative follow up of human chorionic gonadotropin (hCG) levels and ultrasonography are needed. This report describes a rare case of persistent trophoblastic implants to the ovary and peritoneum 40 days after laparoscopic salpingectomy. Treatment consisted of laparoscopic excision with biopsy forceps and bipolar, followed by medical treatments. So we report with a brief review of literatures.

Uterine prolapse complicating pregnancy / 대한산부인과학회지

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.

Spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy / 대한산부인과학회지

Ectopic pregnancy and appendicitis in pregnancy are two most common causes of acute abdomen in young women and differenciation of these diseases is very difficult. Heterotopic pregnancy is a rare event, occuring less than 1:30,000 pregnancies in natural conception cycles. However, with assisted reproduction techniques, this incidence has increased. We experienced a case of spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy. So we report this case with brief review of literature.

Two cases of complete chorioamniotic membrane separation / 대한산부인과학회지

As chorion and amnion fusion usually occurs between 14 and 16 weeks of gestation, sonographic identification of chorion and amniotic membrane separation is a normal finding before 14 weeks. However, persistent separation after 16 weeks of gestation is considered rare and abnormal findings. Complete chorioamniotic membrane separation (CMS) may occur spontaneously, but has also been described as a complication of all invasive intrauterine procedures, including amniocentesis. Complete CMS have a significant morbidity and mortality due to intrauterine fetal death, cord complications, and preterm delivery. Aggressive treatment with hospitalization is necessary. We now report 2 cases of complete CMS identified by prenatal ultrasound; 1 in spontaneous complete CMS diagnosed at 24 weeks of gestation, and health premature child was born at 29+3 weeks of gestation, who was alive and well at present; 1 in complete CMS diagnosed at 21 weeks of gestation after amniocentesis, and fetal demise at 24 weeks of gestation due to cord strangulation by an amniotic band. We experienced two cases of complete CMS and report with a brief review of literatures.

The usefulness of ovarian volume using 3D VOCAL transvaginal ultrasound, antral follicle count and age as predictors of menopause in pre- and postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the sensitivity and specificity of ovarian volume using 3D VOCAL and 2D ultrasound, antral follicle count, and age as predictors of menopausal status in pre- and postmenopausal women. METHODS: The subjects of this study were premenopausal (n=38) and postmenopausal (n=23) healthy women aged between 35 and 57 years of age who were interviewed about social, demographic, and medical conditions. These women underwent transvaginal ultrasound using 3D VOCAL and 2D probe to determine ovarian volume. Chi-square test was applied to evaluate the correlation between ovarian volume, antral follicle count, age and menopausal status. Receiver operating Characteristic (ROC) curves were elaborated to evaluate the sensitivity, specificity and positive and negative predictive values. RESULTS: Premenopausal women presented larger ovaries than postmenopausal women (p<0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p<0.01). ROC curves showed that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe were more sensitive and specific markers of menopausal status than age or ovarian volume using 2D transvaginal probe. CONCLUSIONS: Ovarian volume and antral follicle count differ according to age in pre- and postmenopausal women. The data suggest that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe are quite useful in predicting menopausal status.

The Analysis of the Dietary Factors Related to Climacteric Symptoms in Middle-aged Women / 대한지역사회영양학회지

The purpose of this study was to investigate the dietary intakes in middle-aged women (pre and postmenopausal) and relation to climacteric symptoms. We conducted the anthropometric measurements, climacteric symptoms survey, and dietary intake to assess the nutrient intakes. Also, dietary quality indices were evaluated. The subjects, over 40 years old, were 168 middle aged women ( pre = 74, postmenopausal = 94), mean age was 48.9 +/- 3.6yr. The anthropometric measurements showed that 59% of subjects were overweight and obese. Climacteric symptoms that were answered "yes" in 50% plus in the subjects, were dry eyes, forgetfulness, difficult concentration, large joint pain (shoulder), fatique, backache, dry skin, joint pain (ankle and knee), dry mouth, dizziness, depression and lonesomeness, snore, morning stiffness, and hot flash. Some symptoms showed significant difference between pre and postmenopausal groups. The average energy intake was 1602.1 Kcal, which was 82% of the Korean EER. The subjects had lower vitamin A, riboflavin, folic acid, Fe, Zn and Ca intake than Korean RI. The lowest nutrient intake was Ca. The mean of food intake was 1294.2 g and MAR of diet quality indices was 0.83. In relation to dietary factors with climacteric symptoms, significant correlations have been found between total protein, animal protein, lipid, cholesterol and niacin intake and "fatique", energy, carbohydrate, thiamin, vitamin B6, folic acid, vitamin C, Na, K and Fe intake and "dry skin", Ca intake and "difficult concentration". Our results indicate that dietary factors (food and nutrients intake, INQ, NAR, MAR) may effect the prevention and reduction of some climacteric symptoms in middle aged women.

Comparison of symptoms and characteristics in patients with urethral hypermobility and intrinsic sphincter deficiency (ISD) in female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: To evaluate how patients in the four diagnosis groups differ in their symptoms and other characteristic levels in female stress urinary incontinence METHOD: A retrospective chart review of 240 patients with stress urinary incontinence was performed. Patients were categorized as intrinsic sphincter deficiency (ISD) or stress urinary incontinence (SUI). Within these groups, patients with hypermobility were separated from those without hypermobility. And then just patients with hypermobility were compared. Information on several types of symptoms and characteristics were captured for all patients. RESULTS: There are nothing to do with among 4 each groups and 6 symptoms (frequency, urgency, postvoid dribbling, voiding difficulty, hematuria, recurrent infection) in stress urinary incontinence. Only in diabetic status and antiincontinence surgery did the diagnosis groups differ statistically. In diabetes, patient in the ISD without hypermobility tended to have a higher prevalence of diabetes than the other 3 groups (p=0.007). Patients in the ISD with hypermobility group were more likely to have antiincontinence surgery than thosein the SUI with hypermobility group (p=0.046). No other statistical comparisons were significant at the 0.05 level, although there is some evidence that patients in the ISD with hypermobility group were more likely to have a previous hysterectomy than those in the SUI with hypermobility group (p=0.072). Patients in the ISD without hypermobility group had the largest mean and median age among the four groups, and a statistically significant difference in age was detected across all groups (p<0.001). More specifically, the ISD without hypermobility group was significantly older than the SUI with hypermobility group. CONCLUSION: There was no statistically significant among 4 each group according to each 6 symptom in stress urinary incontinence. Of the variables, diabetes, antiincontinence surgery history, hormonal use, parity and age tended to have a statistically significant difference.

A case of cesarean scar ectopic pregnancy / 대한산부인과학회지

Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Surgical management can be safe and effective and medical treatment can be selected as appropriate selection criteria. Patients with history of a pregnancy in a cesarean delivery scar should be advised of the risk for future uterine rupture and placenta accreta. We experienced a case of ectopic pregnancy with treatment of surgical excision and report with a brief review of literatures.