Subtotal vaginal hysterectomy / 대한산부인과학회지

The importance of minimal invasive surgery has increased. Interest in vaginal hysterectomy is rising. Controversy remains regarding the value of conservation of the cervix at hysterectomy. These factors stimulate interest in subtotal vaginal hysterectomy (SVH). SVH is a simple procedure that carries a low risk of morbidity. It can be an option in the treatment of patient with benign conditions of the uterine corpus who desire the retention of the cervix. This desire may arise from concern about possible subsequent bowel, urinary, sexual dysfunction, as well as from other non-clinical issues. We performed SVH in two patients of uterine leiomyoma. Our report includes a brief review of literature.

The clinical inflammatory reaction of Interceed(R) after laparoscopic surgery / 대한산부인과학회지

OBJECTIVE: Adhesions resulting from surgery may well be the most signigicant iatrogenic factor contributing to infertility and pelvic pain. Recently surgical barriers which mechanically separate opposing surfaces during tissue healing have been devised. Interceed(R) is an absorbable oxized regenerated cellulose barrier that adheres to the site of injury, converts into a gel, spontaneously maintains its position and dose not necessitate sutures. The goal of the study was whether the use of Interceed(R) elicits an inflammatory reaction when it remains foreign materials after laparoscopic surgery. METHODS: This randomized prospective study inculded 207 patients who had undergone laparoscopic operation at the department of Obstetric and Gynecology, Chosun University hospital, from January 2002 to December 2004. Of these 207 patients, 102 underwent laparoscopic operation with applying Interceed(R) (Group 1) and 107 underwent laparoscoic operation without applying Interceed(R) (Group 2). The WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-Reactive Protein), body temperature were compared postoperatively. P<0.05 was considered statistically signigicant. RESULTS: Preoperative WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature of two groups were no significant difference between Group 1 and 2. At postoperative 4th, 10th, 28th day, WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature, vaginal cuff tenderness of two groups were not significantly different between Group 1 and 2. DISCUSSION: We found that the use of Interceed(R) do not elicit an inflammatory reaction through laboratory finding and clinical finding although it remains foreign material after laparoscopic surgery. So we can use Interceed(R) for preventing adhesion safely.

Clinical Analysis of 739 Cases of Midtrimester Amniocentesis / 대한주산의학회잡지

OBJECTIVE: To analyze the change of indications and chromosomal abnormalities according to patient's age and indications in midtrimester genetic amniocentesis. METHODS: This study was reviewed 739 genetic amniocentesis results which were performed at Kwangju Christian Hospital from 1995 to 2004, as prenatal genetic diagnosis for the possibility of chromosomal abnormality of fetus. Age distribution, gestational weeks, indications of amniocentesis and cytogenetic results were the key factors for the analysis. RESULTS: Maternal ages were ranged from 25 to 45, mostly 25~39, Of indications of prenatal genetic amniocentesis, abnormal maternal serum marker was the most common (49.8%), and followed by advanced maternal age (31.1%). The frequency of abnormal karyotypes was 4.6% (34/739). The incidence of abnormal karyotype according to indication had statistical significance in abnormal ultrasonographic finding. CONCLUSION: Among the several indications for prenatal cytogenetic diagnosis, ultrasonographic abnormalities and abnormal maternal serum markers might be important indications. Especially, ultrasonographic abnormalities could be the predictive markers for abnormal fetal karyotypes.

A Case of Primary Carcinoma of the Fallopian Tube / 대한산부인과학회잡지

Primary carcinoma of the fallopian tube is an extremely rare and accounts for approximately 0.34-1.8% of all gynecologic malignancies. Preoperative diagnosis was difficult due to nonspecific symptoms and signs. This case of primary fallopian tube adenocarcinoma was confirmed postoperatively on the basis of the pathologic examination. The histology and behavior of fallopian tube cancer are simillar to ovarian cancer, so evaluation and treatment are similar to that of the ovarian cancer. We have experienced a case of primary carcinoma of the fallopian tube and so report with brief review of the literature.

A Case of Squamous Cell Carcinoma of Right Ovary Developed in a Patient with Bilateral Mature Cystic Teratomas / 대한산부인과학회잡지

Squamous cell carcinoma of the ovary is a very rare malignant tumor originating from malignant transformation of mature cystic teratoma, usually being reported in about 1-3%. It is hard to know the presence of malignant transformation of mature cystic teratoma before operation. So, in case of old age, huge ovarian mass, elevated tumor marker, and operative findings including adhesion, hemorrhage, necrosis and irregular cystic wall, we should suspect malignant transformation. And then we had better do frozen biopsy. Several authors reported the poor prognosis of this malignancy but there is no consensus on optimal therapy because of its rarity. In early stage, curative treatment is possible through only surgical intervention. We experienced a case of squamous cell carcinoma of right ovary developed in a patient with bilateral mature cystic teratomas. We present it with a brief review of literatures.

Cloning and Expression Pattern of FSTL1 mRNA in Normal Myometrium and Uterine Leiomyoma / 대한산부인과학회잡지

OBJECTIVE: To study the influence and cloning of differentially expressed genes in human female normal myometrium and uterine leiomyoma tissue. METHODS: In this experiment, human uterus tissues (n=25) were taken for total RNA isolation by using Trizol reagent. Differential display was performed by using GeneFishingTM DEG Kit and processed to cDNA sequencing and gene cloning for Follistatin-like 1 (FSTL1). Data were analyzed with the image Master VDS software and statistical significance was defined as p<0.05 by paired t test results. RESULTS: FSTL1 mRNA expression level was significantly higher (p<0.05) in normal and adjacent normal myometrium tissues than uterine leiomyoma tissue of women in the reproductive age. Whereas in the menopausal age, FSTL1 mRNA expression level was significantly higher (p<0.05) in uterine leiomyoma than normal myometrium. There was no significant differences between uterine leiomyoma and adjacent normal myometrium. CONCLUSION: Although the mechanisms of FSTL1 gene were uncertain, FSTL1 seemed to play an important role in the growth of uterine leiomyoma, it also might be related to the regulation of uterine leiomyoma growth inhibiting factors by modulating Follistatin related protein gene (FLRG) system.

Clinical Study of Vaginal Total Hysterectomy: A Review of 110 Cases / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effectiveness and the safety of vaginal total hysterectomy. METHODS: We reviewed the medical records of the 110 patients who underwent vaginal total hysterectomy for the indications other than uterine prolapse from August 2001 to September 2002 at our hospital. RESULTS: The average operating time was 48.7 minutes (range from 20 min to 180 min) and the mean uterine weight was 331 gram (range from 60 g to 890 g). The most common indication for hysterectomy was uterine myoma (59%). No serious complications were occurred but conversion to laparotomy was occurred in 1 case. CONCLUSION: Vaginal total hysterectomy would be recommended method for removing uterus even in the absence of prolapse and previous operation history.

A Case of Successful Treatment with Methotrexate Injection on Intramural Pregnancy Embedded in the Myometrium of Previous Cesarean Section Scar / 대한산부인과학회잡지

Intramural pregnancy implanting in the previous cesarean section scar is one of the rarest form of an ectopic pregnancy and probably the most dangerous form because of its risk of rupture and hemorrhage. For its sonographic diagnosis, the gestational sac should be in the anterior wall of uterine isthmic portion, there should be no myometrium between bladder and gestational sac, and it should be verified that uterine cavity and cervix should be isolated from gestational sac. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are desirable. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, treated with systemic methotrexate injection. So, we report this case with a brief review of the literature.

The Comparative Analysis of Cytology, Colposcopically Directed Biopsy and Final Histopathology in Diagnosis of Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: To investigate the necessity of colposcopically directed biopsy for more accurate detection of cervical neoplasm. METHODS: Cytology and colposcopically directed biopsy were performed in 114 patients and the patients were subsequently underwent conization or hysterectomy from January, 1998 to December, 2001. RESULTS: The complete diagnostic agreement of cytology with permanent biopsy was 57.9% (66 of 114) and the diagnostic agreement within one degree was 80.6% (92 of 114). The complete diagnostic agreement of colposcopically directed biopsy with permanent biopsy was 62.3% (71 of 114) and the diagnostic agreement within one degree was 85.1% (97 of 114). The difference between two tests was statistically significant (p<0.001). CONCLUSION: We concluded that colposcopically directed biopsy can reduce the false negative rate of cytology for screening test of cervical neoplasm. The difference between colposcopically directed biopsy and permanent biopsy was caused by inappropriate resection of the lesion and unskilled physician.

A Case of successful delivery after hysteroscopic removal of intrauterine device with missing tail during early pregnancy / 대한산부인과학회잡지

In the case of pregnancy complicated by intrauterine device, complications such as ectopic pregnancy, septic abortion, preterm delivery are increased significantly. Especially in relation to intrauterine pregnancy, IUD should be removed to prevent complication. But when the tail is missed, therapeutic abortion has been done as an alternative method conventionally. Recently we experienced a case of hysteroscopic removal of IUD complicated by intrauterine pregnancy of 9th week without any harm to the G -sac or embryo. And she delivered healthy girl weighing 2950 gm. So we report this case with the review of articles related.

A case of prune-belly syndrome in antenatal ultrasonography / 대한산부인과학회잡지

Prune-belly syndrome is a rare compound fetal anomaly, characterized by absence or hypoplasia of abdominal wall musculature associated with urinary tract abnormalities and cryptorchidism. The prenatal ultrasound diagnosis was based on the findings of a lower abdominal cystic echo caused by abnormal dilatation of the bladder, upward compression of small intestines and decreased amniotic fluid volume. We experienced a case of Prune-belly syndrome diagnosed by ultrasound in a 12 weeks fetus following to IVF-ET pregnancy. Termination was performed at 12 weeks and autopsy confirmed the distended bladder, absence of abdominal muscles and urethra. So, we reported this case with a brief review of literature.

A Case Of Intrauterine Fetal Death Due To Stricture Of The Umbilical Cord / 대한산부인과학회잡지

Umbilical cord stricture is a very rare cord abnormality that cause intrauterine fetal death. An extreme focal deficiency of Wharton's jelly is suggested as a cause of cord stricture, and was most commonly occurred at the fetal end of umbilical cord. Antenatal detection of umbilical cord stricture is very difficult. We experienced a case of the intrauterine fetal death due to umbilical cord stricture, and we report this case with a brief review of literatures.

A Case of Pelvic Actinomycosis Simulating Metastatic Ovarian Cancer / 대한산부인과학회잡지

Actinomycosis is a rare disease in human and has variable clinical features, which make the diagnosis difficult. Actinomycosis may be confused with malignancy and other inflammatory diseases because of its infiltrative nature and its tendency to invade normal anatomic barriers. We have experienced a case of abdominal actinomycosis combined with ovarian mucinous cystadenocarcinoma and report this case with brief review of literatures.

A case of cystic change of pelvic retroperitoneal Schwannoma misdiagnosed as an ovarian tumor / 대한산부인과학회잡지

Retroperitoneal Schwannoma is relatively rare and benign tumor originating from Schwann cell. Schwannomas arising in the retroperitoneum are infrequently reported. The majority of Schwannoma is found incidentally and misdiagnosed for other benign conditions both clinically and radiologically. We report a case of a benign retroperitoneal pelvic Schwannoma which was preoperatively misdiagnosed as an ovarian tumor with brief review of literatures.

A case of heterotopic pregnancy after ovulation induction and intrauterine insemination / 대한산부인과학회잡지

Heterotopic pregnancy is defined as simultaneous intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has been increased. This increased incidence is explained by the rise in PID, pelvic surgery, IUD and assisted reproductive technologies-in vitro fertilization/gamate intrafallopian insemination/intrauterine insemination. Thus careful pelvic examination combined with serial beta-hCG determinations and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in ovulation induction and intrauterine insemination with a brief review of literature.

Measurement of Changes in Cerebral Blood Flow Velocity During Hemodialysis / 대한신장학회잡지

Hemodialysis is a safe and effective treatment for uremic patients but hemodynamic changes during hemodialysis is suggested to be the possible cause of encephalopathy. However, few studies have evaluated the cerebral circulation of and the effects of hemodialysis. Therefore, this study was performed to evaluate the cerebral blood flow by transcranial doppler. The study populations were 12 male patients who ranged in age from 28 to 58 years(mean:57) and were receiving maintenance hernodialysis for 3.8 years(0.5-11.5 years). Mean blood flow velocity(MFV), pulsatility index(PI) and resistance index(RI) were measured in carotid artery(CA), middle cerebral artery(MCA), anterior cerebral artery(ACA) and posterior cerebral artery(PCA) before, during and after hemodialysis. Simultaneously, we also checked variables(body weight, blood pressure, arterial blood gases, hematocrits, and other biochemical parameters) which might affect cerebral blood flow. MFV during(70.5+/-20.3 vs. 60.0+/-211cm/sec) and after(vs. 60.6+/-13.7cm/sec, p<0.01) hemodialysis in CA showed significant reduction as compared to the that of before hemodialysis, but other vessels(MCA, ACA and PCA) showed no significant changes. There were no significant changes in PI and RI before, during and after hemodialysis. Body weight, PaCO(2), blood urea nitrogen and hematocrit changed significantly during and after hemodialysis as compared to those of before hemodialysis, but correlation between changes of MFV and these variables was not observed. Hemodialysis and its associated physiologic changes are not associated with cerebral blood flow, and this result suggests the well-preservation of autoregulation of cerebral blood flow during and after hemodialysis.

A case of ovarian remnant syndrome following total abdominal hysterecomy with bilateral salpingoophorectomy / 대한산부인과학회잡지

Ovarian remnant syndrome is a rare condition which develops when functional ovarian tissue is left in situ after intended bilateral oophorectomy. It produces clinically significant syndrome, namely chronic pelvic pain and dysmenorrhea. Although the true incidence of this syndrome is unknown, an apprant increase in incidence has been reported. We have experienced a case of ovarian remnant syndrome showing chronic pelvic pain and palpable abdominal mass after difficult gynecologic operation. So, we report this case with a brief review of literatures.

A Case of Rapidly Growing Huge Granulosa Cell Tumor of the Ovary / 대한산부인과학회잡지

Ovarian granulosa cell tumor is a uncommon low-grade feminizing malignancy. Its natural history shows slow growth without pain. It often reveals to be very large sized mass when diagnosed, and is confined to the involved ovary in many cases. Complete surgical removal is primary treatment and recurrences thereafter are relatively common. Postoperative adjuvant therapy including reoperation, chemotherapy, radiation therapy or a combination therapy has been used with various degrees of success. We experienced a case of huge ovarian granulosa cell tumor occupying whole abdominal cavity by rapid growth, which is presented with a brief review of corresponding literatures.

A case of heterotopic pregnancy following in vitro fertilization and embryo transfer / 대한산부인과학회잡지

Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has increased after wider use of assisted reproductive technology. The rising incidence presents a serious problem as the diagnosis of this potentially fatal condition is often missed. Careful pelvic examination combined with serial beta-hCG determinations, and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in vitro fertilization and embryo transfer(IVF-ET) with a brief review of literature.

Clinical outcome of intrauterine adhesion after Resectoscopy / 대한산부인과학회잡지

OBJECTIVES: From February 1995 to April 1998, those patients who had visited for evaluation of infertility, shown abnormal endometrial pattern on hysterosalpingography underwent resectoscopic operation. We evaluated about its therapeutic effect, recurrence rate of uterine adhesion and effectiveness of its assisted method. METHOD: We have reviewed 45 cases of intrauterine adhesion, classified as a central type, marginal type and multiple type. We used 26F resectoscope made in Storz for operation and inserted Lippes loop or pediatric foley catheter for prevention of readhesion. For promoting reepithelialization, conjugated estrogens(premarin) 5mg daily for 30 - 50 days were given and then 10mg of medroxyprogesterone acetate(provera) were added daily for the last 10 days. We evaluated the uterine cavity condition preoperatively and postoperatively by using hysterosalpingography. RESULT: In 45 cases, 41 cases were followed up postoperatively. 21 cases were markedly improved, 12 cases were improved and 8 cases were not improved or recurred on hysterosalpingography. In 41 cases, for prevention of readhesion 20 cases were used pediatric foley catheter and 5 cases(25%) were recurred. 21 cases were used Lippes loop and 3 cases(14%) were recurred. Pregnancy outcome was as follows;15 cases were pregnant and 10 cases delivered a viable infant, 3 cases aborted spontaneously, 1 case was ectopic pregnancy and laparoscopic salpingectomy was done, 1 case was ongoing pregnancy. CONCLUSION: This report suggests that resectoscopic operation is very effective in the treatment of intrauterine adhesion(therapeutic rate of 81%) and that the use of Lippes loop seems like to have the less recurrence rate than the use of pediatric foley catheter in prevention of postoperative readhesion, but more experience and further follow-up are necessary to obtain more detailed conclusions.