A case of placenta accreta successfully treated with methotrexate / 대한산부인과학회지

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though hysterectomy is a definitive therapy, there are some occasions that conservation of the uterus is desired by the patient and bleeding is not excessive. We report a case successfully treated using methotrexate in patient whose placenta was not detached from the uterus with a brief review of literature.

Expandable Metallic Stent Placement for Nutcracker Syndrome / 대한비뇨기과학회지

Herein, a new left renal vein stenting procedure (expandable metallic stent placement), which provided relief for an 18-year-old man incapacitated by an intermittent gross hematuria, is reported. The placement of an expandable metallic stent is a minimally invasive therapy, and a simpler and more physiological therapy than previous approaches to Nutcracker syndrome.

Superficial Thrombophlebitis of the Dorsal Vein of the Penis (Penile Mondor's Disease) / 대한비뇨기과학회지

Herein, two cases of penile Mondor's disease are described. The first was a 45-year-old man who complained of a small subcutaneous induration, with localized discomfort at the distal rim of the coronal sulcus of the penis. The other was a 46-year-old man who complained of similar symptoms of penile induration. The lesions were surgically removed under local anesthesia, and found to be thromboses of the penile superficial dorsal vein. As a result, the diagnoses of Mondor's disease of the penis were confirmed.

Intrascrotal Extratesticular Epidermal Cyst / 대한비뇨기과학회지

An epidermal cyst, presenting as an intrascrotal tumor, with no relation to the testicles or cord structures, is a rare benign tumor. Their etiology is unknown, but the most widely accepted theory on the histogenesis of testicular epidermal cysts is that they are the end result of a monolayer teratoma arising from germ cells; however, an extratesticular epidermoid cyst is believed to be an abnormal closure of the median raphe and urethral groove. An extratesticular epidermal cyst is normally subcutaneous, and can be localized anywhere along the median raphe, from the distal penis to the anus. To our knowledge, there has been no case reported in the Korean literature. A case of an intrascrotal epidermal cyst is reported in a 44-year-old man.

Efficacy and Toxicity of Gemcitabine Plus Cisplatin Chemotherapy in Advanced Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: To assess the response to, and toxicity of, combination chemotherapy, with gemcitabine and cisplatin, in patients with advanced transitional cell carcinoma of the urothelial tract. MATERIALS AND METHODS: Thirty-seven patients with advanced transitional cell carcinomas were treated with gemcitabine, 1,000mg/m2, intravenously for 30 minutes, on days 1, 8 and 15 and cisplatin, 70mg/m2, for 1 hour on day 2 of each 28-day cycle. Twenty-four that completed more than 3 cycles were evaluated for their response, but all patients were evaluated for the toxicity. The full dose of the drugs was administered to all patients. RESULTS: Three(12.5%) of the 24 patients achieved a complete response and 2 (37.5%) achieved a partial response, showing an overall response rate of 50%. The main toxicities were myelosupression, with an incidence of 34% thrombocytopenia, 40% leukopenia and 28% anemia, but only 6% of grades 3 to 4. Non-hematological toxicity was mild, with a low incidence of 46% nausea and vomiting, and only 6% of grades 3 to 4. CONCLUSIONS: Combination chemotherapy, with gemcitabine and cisplatin, exhibits significant activity and favorable toxicity in advanced transitional carcinomas, although long-term follow-up and further studies are warranted.

Tension-Free Vaginal Tape Operation in Stress Urinary Incontinence: Comparison between Local Versus General Anesthesia Groups / 대한비뇨기과학회지

PURPOSE: To assess the differences between local and general anesthesia, with the tension-free vaginal tape (TVT) operation, in relation to the clinical outcome, surgical complications and degree of satisfaction of women with stress incontinence. MATERIALS AND METHODS: A nonrandomized, retrospective study was performed on 65 patients having undergone a tension-free vaginal tape operation between April 1999 and June 2001. After explaining the anesthetic procedure to the patients, 35 did not want to be admitted, so chose local anesthesia, with the other 30 choosing general anesthesia. The clinical outcomes of the operation were evaluated by telephone interviews, and the definition of success or failure determined by Stamey's criteria. RESULTS: The mean follow-up periods of the patients with local and general anesthesia were 14.2 (6.1-31.3) and 12.6 (6.4-30.7) months, respectively. The success rates with local and general anesthesia were 94.2 and 96.6%, respectively, with no significant difference between the two groups. The mean post-void residual urine volumes were 51.6 (8-210) and 47.4 (5-180)ml, respectively, and the indwelling periods of the Foley catheter were 1.9 (1.1-12.8) and 2.2 (1.3-11.5) days, respectively. Bladder perforations occurred in 2 patients under local anesthesia and in 3 under general anesthesia, which was cured by an indwelling catheter over a 2 day period. CONCLUSIONS: The TVT procedure was a very effective and safe surgical treatment for female stress urinary incontinence, and there were no differences in the success rates and surgical complications between anesthesia groups. Considering the cost and admission period, local anesthesia may be better than general anesthesia, but a longer-term follow-up will be required.

Tension-Free Vaginal Tape Operation in Stress Urinary Incontinence: Comparison between Local Versus General Anesthesia Groups / 대한비뇨기과학회지

PURPOSE: To assess the differences between local and general anesthesia, with the tension-free vaginal tape (TVT) operation, in relation to the clinical outcome, surgical complications and degree of satisfaction of women with stress incontinence. MATERIALS AND METHODS: A nonrandomized, retrospective study was performed on 65 patients having undergone a tension-free vaginal tape operation between April 1999 and June 2001. After explaining the anesthetic procedure to the patients, 35 did not want to be admitted, so chose local anesthesia, with the other 30 choosing general anesthesia. The clinical outcomes of the operation were evaluated by telephone interviews, and the definition of success or failure determined by Stamey's criteria. RESULTS: The mean follow-up periods of the patients with local and general anesthesia were 14.2 (6.1-31.3) and 12.6 (6.4-30.7) months, respectively. The success rates with local and general anesthesia were 94.2 and 96.6%, respectively, with no significant difference between the two groups. The mean post-void residual urine volumes were 51.6 (8-210) and 47.4 (5-180)ml, respectively, and the indwelling periods of the Foley catheter were 1.9 (1.1-12.8) and 2.2 (1.3-11.5) days, respectively. Bladder perforations occurred in 2 patients under local anesthesia and in 3 under general anesthesia, which was cured by an indwelling catheter over a 2 day period. CONCLUSIONS: The TVT procedure was a very effective and safe surgical treatment for female stress urinary incontinence, and there were no differences in the success rates and surgical complications between anesthesia groups. Considering the cost and admission period, local anesthesia may be better than general anesthesia, but a longer-term follow-up will be required.

Incidence of Overactive Bladder in Benign Prostatic Hyperplasia and the Efficacy of Combination Therapy of Alpha Blocker with Tolterodine / 대한비뇨기과학회지

PURPOSE: The incidence of overactive bladder (OAB) and the efficacy of alpha blocker and tolterodine combination therapy were examined in patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2001 and December 2001, 144 BPH patients were subdivided into those with BPH, or BPH with OAB, based on urodynamic studies. All patients were treated with alpha blockers for 3 months. Patients with no symptomatic improvement were treated with alpha blockers and tolterodine for 2 months. An increase in the International prostate symptom scores (IPSS) of more than 3 points after medication was considered an improvement, but if not, as a failure. RESULTS: Of the 144 patients, 76 (53%) had BPH and 68 (47%) had BPH with OAB. The patients with BPH and OAB were older (p<0.05), but no differences were observed in the serum creatinine, IPSS, prostate volume, maximum flow rate or post-void residual urine (PVR) between the 2 groups. After 3 months treatment with alpha blockers, 79% (60/76) of the BPH and 35% (24/68) of the BPH with OAB patients had improved (p<0.05). Of the patients showing no improvement, 38% (6/16) with BPH and 73% (32/44) with BPH and OAB showed improvement after the addition of tolterodine. CONCLUSIONS: The combination therapy was more effective than alpha blockers alone in the treatment of patients with coexisting BPH and OAB. We recommend identifying these patients with an initial urodynamic study, which allows for the appropriate management and identification of those patients that may benefit from a more invasive treatment.

The Effect of GM-CSF Supplementation in Culture Medium in the Human IVF Programs / 대한불임학회지

OBJECTIVE: Granulocyte-macrophage colony stimulating factors known to be secreted in murine and human reproductive tract. The development of human, bovine and murine embryos could be promoted by addition of GM-CSF in culture medium. However, the pregnancy and implantation rate of embryos cultured in GM-CSF have not been evaluated. The aim of this study was to assess the effect of GM-CSF in embryo development, pregnancy and implantation rate. METHODS: A total of 191 IVF cycles were divided into control and GM-CSF supplement group (control =96, GM-CSF=95). The embryos were cultured for three day with or without 2 ng/ml of recombinant human GM-CSF. The quality of embryo, developmental velocity, pregnancy and implantation rates were compared. RESULTS: There was no difference in age, number of gonadotropin ampules used, number of oocytes and fertilization. The number of ICSI cycle was higher in GM-CSF group. In GM-CSF group, G-1 grade embryos were the highest in proportion (56.4%), while G-2 grade embryos were highest (44.3%) in control group. The developmental velocity of embryos were not different between GM-CSF and control group. The pregnancy and implantation rates were significantly higher in GM-CSF group than control (47.4% vs. 33.3%, 17.0% vs. 11.1% respectively). CONCLUSION: By adding GM-CSF in culture medium, the quality of embryo, pregnancy and implantation rate could be improved.

A Case of Arteriovenous Hemangioma of the Scrotum and the Urethra / 대한비뇨기과학회지

Hemangioma is the most common congenital anomaly in the human. It represents a proliferation of endothelial cells and has been characterized as a benign neoplasm. Hemangiomas involving the genitalia comprise 2% of all such masses. Arteriovenous hemangioma is a benign congenital lesion that rarely involves the scrotum or urethra and primarily presents during childhood. We report a case of subcutaneous scrotal and urethral hemangioma that has caused persistent urethral bleeding in a 14-year-old boy who was treated by en bloc excision.

Clinical Evaluation of Ovarian Tumors associated with Pregnancy / 대한산부인과학회잡지

No abstract available.

Influence of Maternal Age on Embryo Quality and the Frequency of Multiple Pregnancy in IVF-ET Program / 대한불임학회지

OBJECTIVE: This study was performed to evaluate the influence of maternal age on embryo quality and the frequency of multiple pregnancy in IVF-ET program. METHOD: 86 conventional IVF-ET cycles were divided into three groups according to the age by 5 year (group A: 26-30, group B: 3135, group C: 36-40 yrs). The in vitro fertilization and development outcome (fertilization, cleavage and high quality embryo rate) and the pregnancy outcome (pregnancy, implantation, G-sac/high quality embryo and multiple pregnancy rate) were examined. And then, these results were compared among the groups. RESULTS: The rates of fertilization (62.7, 68.5 and 65.4%, respectively) and cleavage (95.6, 97.6 and 98.0%, respectively) were not different among the groups. And the high quality embryo (HQE) rate also was not different among the groups (61.8, 62.9 and 62.8%, respectively). The pregnancy rate of group C (23.3%) was significantly lower than that of group A (41.2%) and B (48.7%). And the implantation rate was significantly decreased to group B (32.2%) and C (14.3%) when compared to group A (71.4%) and B (36.8%). CONCLUSION: The pregnancy rate was significantly decreased over 35 years. The G-sac/HQE and multiple pregnancy rate were significantly high below 31 years. Thus, these results suggest that the number of high quality embryo transferred should be limited by the age and another criteria for embryo quality evaluation were required for single embryo transfer.

A Clinical Study on the Incompetent Internal Os of the Cervix / 대한산부인과학회잡지

OBJECTIVE:Our goal was to evaluate the clinical characteristics and statistical analysis in incompetent internal os of the cervix(IIOC) METHOD: At Department of Obstetrics and Gynecology, Eulgi Hospital and Eulgi university Hospital from January 1, 1991 to December 31, 1997, 296 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation. Of this, 38cases were follow up lost, so 252 cases were analayzed. Diagnostic criteria was previous history of painless cervical dilatation, followed by spontaneous abortion or preterm birth, and acceptance without resistance at the internal os of No. 8 Hegar dilator. RESULT: Incidence of IIOC was 1.61%, 1 in 60 deliveries. Most frequent age group was in 28-30 years old group and mean age was 30 years old. Total number and mean number of gravida was 818 and 3.2. The most common contributing factor was previous artificial abortion(77%), and cervix dilatation(9%), old cervical laceration(4.3%) etc, was followed. Operation methods were McDonald operation(56%) and modified Shirodkar operation(44%). The Success rate of McDonald and modified Shirodkar was 78.1% and 88.1%. Successful fetal salvage rate was 82.5%, and the highest success rate was 86.9% in 14-18th weeks of gestation group. The more cervix dilate, the more failure occured. Causes of operation failure was premature rupture of membrane(54.5%), preterm labor(43.2%) and fetal death in utero(2.3%). Delivery method after operation was vaginal delivery(146cases, 70.9%) and cesarean delivery(60cases, 29.1%). Cause of cesarean delivery was previous cesarean section(43.3%), breech presentation(16.7%), cephalopelvic disproportion(15%), prolonged labor(6.7%), fetal disttess(6.7%), twin(5%), placenta previa(3,3%) and abruptio placenta(3.3%). CONCLUSION: The 14-18th weeks of gestation group & no cervical dilatation group has higher success rate, which indicate early diagnosis and appropriate timing of operation is probably associated with a greater operation

Follow-up Study on Cell-mediated Immune Responses In Syphilitic Patients after in vitro Stimulation with the 47 kDa Antigen of Treponema pallidum / 대한면역학회지

Present study was aimed to investigate the immunological activities of the 47 kDa protein antigen from Treponema pallidum and conducted on 12 patients with syphilis (early, late, spontaneously healed, congenital and treated patients) followed by therapy. Peripheral blood mononuclear cells (PBMC) were obtained three times from each patient, on admission before the initiation of therapy, 1 and 6 months later. Eleven (96.7%) of the patients prior to therapy, showed depressed lymphoproliferative responses to the 47 kDa antigen (stimulation index <4) by 3H-thymidine incorporation assay. However, these T cell responses were seemed to be transient because most of the patients (63.6%) exhibited significantly higher lymphoproliferation after therapy. Before therapy, PBMC from spontaneously healed syphilis patients resulted in significantly increased gene expression of IFN- and proinflarnmatory cytokines, such as TNFa, IL-1B and IL-6, in response to the 47 kDa. Patients with late latent and late congenital syphilis exhibited lower IFN-r and proinflammatory cytokine mRNA expression than spontaneously healed syphilis group did. After therapy, IFN-r and proinflammatory cytokine mRNA expressions were gradually reduced in these groups. On the other hand, IFN- and proinflammatory cytokine gene expressions were considerably depressed in early syphilis patients, but these patients went on to express prominent IFN-r and proinflamrnatory cytokine mRNA with treatment. These data suggest that the pattern of cellular immune response in response to the 47 kDa antigen may be involved in the evaluation of the clinical course and outcome of syphilis followed by therapy.

Clinical study for Patients with Cervical Cancer who had undergone Radical Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to analyze the clinical study for patients with cervical cancer who had undergone radical hysterectomy. METHOD: The subjects of this study were one hundred and sixty two patients with cervical cancer who had undergone radical hysterectomy at Eulji Medical College Hospital, Taejon, Korea, from January 1983 to December 1992. We reviewed the medical record retrospectively and analyzed the data. RESULT: The distribution of patients by age was found in the order of 50 decade and 60 decade, 40 decade. Those by the clinical stages were as follows: Stage Ia, 12 cases(7.4%); Stage Ib, 84 cases(51.9%); Stage IIa, 39 cases(24.1%); Stage IIb 27 cases(16.7%). The results of histopathologic type were distributed as follows: squamous cell carcinoma was 91.9%, adenocarcinoma was 4.9% and adenosquamous cell carcinoma was 3.1%. The histologic subtypes of squamous cell carcinoma(149 cases) were as follows: Large cell non-keratinizing type was 75.9%, large cell keratinizing type was 14.8% and small cell type was 1.2%. The frequancy of lymph node metastasis was 22.9% in stage I and 31.8% in stage II. The overall incidence of lymph node metastasis was 26.4%. The frequency of external radiation therapy done after radical hysterectomy was 63.5% in stage I and 75.8% in stage II. The 5-year survival rate was as follows: The Ia was 100%; Stage Ib, 95.2%(4cases); Stage IIa, 87.2%(5cases); Stage IIb, 77.8%(6cases). The incidence of recurrence was 7.4% and recurrent sites were vaginal stump , rectum and pelvic wall. CONCLUSION: The highest incidence of cervix cancer in age distribution was 50 decade(30.9%) and 60 decade(30.9%). The most common clinical stage was Ib(51.9%) and most frequent pathologic type was squamous cell carcinoma(91.9%). The overall incidence of lymph node metastasis was 26.4% and The most common site of recurrence was vaginal stump. The 5-year survival rate was 100% in the stage Ia, 95.2% in the stage Ib, 87.2% in the stage IIa, 77.8% in the stage IIb.

Evaluation of Methods for Fetal Weight Estimates Using Ultrsound Formula at Term / 대한산부인과학회잡지

A total of 150women with singleton pregnancies who were delivered between 37 and 42weeks gestation had ultrasound scans on elective cesarean section day. The biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC) and femur length(FL) were measured in all cases. Equations of estimated fetal body weight(BWT) for Korean term fetuses using AC alone, BPD/AC, AC/FL, HC/AC/FL, BPD/AC/FL, BPD/HC/AC/FL were made by stepwise multiple regression analysis and were compared with foreign equations such as Campbell(AC), Shepard(BPD/AC), Hadlock I(AC/FL), Hadlock II(HC/AC/FL), Hadlock III(BPD/AC/FL), and Hadlock IV(BPD/HC/AC/FL). The results were as follows. 1. The equations of BWT by sonographic measurement were Equation1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) Equation2 (BPD,AC)logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) Equation3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) Equation4(HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) Equation5(BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. When BPD, AC and FL were measured, the addition of HC didn,t affected to accuracy of EFW 3. The best results of all equations were obtained with our equation 5(Mean error=2.36gm, Mean absolute error=96.39gm, Mean deviation + SD(%)=0.07+0.37) and among foreign equations, the best results were with Hadlock III equation(Mean error=18.35gm, Mean absolute error=107.82gm, Mean deviation + SD(%)=-0.46+0.42) 4. The equations using AC/FL (our equation 3, Hadlock I) are more accurate than those using BPD/AC (our equatione 2, Shepard) when utilizing two parameters. Therefore, equation using AC/FL is recommended when the BPD is unobtainable at term or labor 5. The percentage of cases in which the EFW was within +5% and +200gm of the actual birth weight was highest at our equation 5 for 82% and 89%, Hadlock IV equation for 79%, 88%. 6. Our equations had relatively an equal tendency to under- and overestimate fetal weight, but foreign equations, especially Campbell and Hadlock II equations tended to underestimate. 7. Analysing according to actual birth weight, our all equations gave the most accurate estimates of fetal weigh for birth weight group between 3000-3499gm, but for birth weight group above 3500gm, that was not. At birthweight group above 3500gm, the equations depend on femur length are more accurate than the equations independ on fumr length.

A study on the clinical manifestation and treatment of ectopic pregnancy / 대한산부인과학회잡지

No abstract available.