Surgical approaches for gynecologic malignancies causing peritoneal dissemination / 대한산부인과학회지

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

A case of catamenial hemoptysis / 대한산부인과학회지

Endometriosis is relatively common gynecologic diseases, but pulmonary endometriosis is exceedingly rare among various types of external endometriosis. Patients with pleural pulmonary endometriosis present with chest pain, dyspnea, pneumothorax or pleural effusion in relation to menstruation. Patients with parenchymal pulmonary endometriosis present with hemoptysis at the time of menstruation, with or without lung lesions on their chest X-ray. The diagnosis of pulmonary endometriosis is usually made on the basis of the clinical history and the exclusion of other causes of recurrent hemoptysis including tuberculosis, bronchial carcinoid, pulmonary infarction, chronic bronchitis, congenital abnormalities and carcinoma. It can be treated by progesterone, GnRH agonist, Danazol, surgical treatment etc. Hereby we experienced 23 year-old multiparous woman with catamenial hemoptysis. The site of disease/was localized with bronchoscopy and chest CT scanning, and we treated her with Danazol. The literature associated with pulmonary endometriosis is briefly reviewed.

Minilaparotomically Assisted Vaginal Hysterectomy

Endoscopic hysterectomy is increasingly selected as a current trend to minimize invasion, tissue trauma and early recovery. However it has disadvantages of the difficulty to learn and needs expensive equipments. So we developed a new minimally invasive method of vaginal hysterectomy-minilaparotomically assisted vaginal hysterectomy (MAVH) in order to complement the current laparoscopic surgery. The principle of MAVH is based on suprapubic minilaparotomical incision and uterine elevator that allows access and maximal exposure of the pelvic anatomy and an easy approach to the surrounding anatomy enabling division of round ligaments, Fallopian tubes, tuboovarian ligaments, and dissection of bladder peritoneum. After then, the vaginal phase of MAVH is done by the traditional vaginal hysterectomy. We enrolled 75 consecutive cases and in 73 cases thereof MAVH was accomplished successfully. The technique of MAVH is simple and easy to learn and it involves a small incision causing less pain and complications. This practice does not require expensive equipments. MAVH is considered as a safe and effective alternative method for abdominal hysterectomy in most cases.

Two Cases of Sertoli-Leydig Cell Tumor of Ovary / 대한산부인과학회잡지

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary. It is the most common type of all virillizing ovarian tumors, accounting for less than 0.5% of all primary ovarian neoplasm. Recently, we experienced two cases of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.

Two Cases of Sertoli-Leydig Cell Tumor of Ovary / 대한산부인과학회잡지

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary. It is the most common type of all virillizing ovarian tumors, accounting for less than 0.5% of all primary ovarian neoplasm. Recently, we experienced two cases of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.

A Clinical Study on 570 Cases of Laparoscopy Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical outcome and characteristics of laparoscopy assisted vaginal hysterectomy (LAVH) in gynecologic patients. METHODS: From September, 2001 to February, 2004, total 570 cases of patients were performed LAVH at Gacheon medical school Ghil Hospital. We reviewed medical records and analyzed these cases about age, parity, weight, previous surgery history, operation indication, operation outcome, duration of hospitalization and complication. RESULTS: The results of this study summarized as follows. The mean age of patients was 46.4 +/- 7.2 years old. Average parity of patients was 2.4 +/- 1.4. Average weight of patients was 63.4 +/- 8.2 kg. Previous operation history was 195 cases (34.2%). Most common operation indication was uterine leiomyoma, followed by adenomyosis, combination of leiomyoma and adenomyosis and endometriosis. The mean operation time was 72 +/- 20.6 minutes. The mean duration of hospitalization was 4.5 +/- 0.6 days. The major complication of operation was trocar site bleeding, followed by bladder injury, bowel injury, and ureteral injury. CONCLUSION: LAVH is safe and useful. So it is recommendable to gynecologic patients.

The Usefulness in the Value of Some Infectious Parameters to Predict the Success of Emergency Cervical Cerclage Operation / 대한산부인과학회잡지

OBJECTIVE: To predict the perinatal outcomes of emergency cervical cerclage operation we analyzed some infectious parameters before and after the operation in patients has incompetent internal os of cervix, and compared their results between one success group and one failed group. METHODS: The 13 patients with emergency cervical cerclage and the 31 patients with elective cervical cerclage included in our study. After emergency cerclage, we investigated some infectious parameters as ESR, CRP, and WBC count, every other day. And we compared these values between success and failed group. We also evaluated the difference of these results between emergency cerclage and elective cerclage operation. RESULTS: 1. There were higher values of ESR and CRP after cerclage operation in failed group than those in success group significantly (p<0.05). 2. There also had shown higher values of WBC count at 3 days after operation in failed group than those in success group significantly (p<0.05). CONCLUSION: The infection is one of the most important factors in successful perinatal outcome after emergency cerclage operation and continuous follow up in ESR, CRP and WBC counts after operation can be used to predict the perinatal outcomes in relation to incompetent internal os of cervix.