Hemoperitoneum followed by Red Degeneration of Uterine Myoma / 대한산부인과학회지

Spontaneous intra-abdominal hemorrhage from uterine leiomyomas is rarely encountered. We present a case of a 46-year-old who presented to the emergency room with acute abdominal pain as same as that has experienced for 5-6 times. On examination, the abdomen was diffusely tender, with rebound tenderness in the suprapubic area and in both iliac fossae. Pregnancy test was negative. She had an acute abdomen, dizziness, decreasing hematocrit, and a pelvic mass with free fluid in the pelvic cavity. On transvaginal sonography, 6.3 x 6.1 cm sized hyperechoic mass was visible beside the uterus and CDS. This mass had an ill-defined margin. Large amount of fluid was visible in the CDS and uterovesical pouch. Hemoperitoneum was confirmed by culdocentesis. Magnetic Resonance Imaging revealed a mass with cystic components, diffusely heterogeneous signal intensity and T1 high signal intensity in the left superolateral aspect of uterus. An moderate amount of fluid was found in the pelvic cavity. The patient underwent an exploratory laparotomy. A ruptured, pedunculated, cystic degenerated uterine myoma with active bleeding was found, as well as approximately a liter of free, blood-stained peritoneal fluid and blood-clots. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Agenesis of corpus callosum prenatally diagnosed with fetal MRI: case report / 대한산부인과학회지

Agenesis of corpus callosum is the cerebral malformations whose prognosis is uncertain. But the complete agenesis shows more poor prognosis than partial agenesis. So, the type of agenesis can affect significantly the antepartum management. Recently, there has been a development in diagnostic tools like MRI to overcome these limitations of antenatal ultrasonography. We report a case of agenesis of corpus callosum which was diagnosed by prenatal MRI. This case was confused with Dandy-Walker complex in prenatal ultrasonography and supported in diagnosis by prental MRI.

Clinical application of serum CA 125 and CA 19-9 in Endometriosis / 대한산부인과학회지

OBJECTIVE: The aim of the present study was to investigate the clinical usefulness of serum CA 125 and CA 19-9 levels for diagnosing and determining the severity of endometriosis. METHODS: A total of 112 women who underwent gynecologic surgery between January 1998 and August 2004 were selected in this study. 81 patients had histologically confirmed endometriosis and the remaining 31 had benign ovarian tumor but no obvious evidence of endometriosis. Blood samples were collected in all patients before the operation and the mean values and standard deviations of both serum CA 125 and CA 19-9 levels were measured in various stages of disease. Both tumor markers were also measured in the control group. The results were compared to determine the usefulness of CA 125 and CA 19-9 in diagnosing and predicting the severity of endometriosis. As a results, new cutoff values of serum CA 125 and CA 19-9 in endometriosis were obtained. RESULTS: The mean levels of serum CA 125 and CA 19-9 in patients at stage III and IV of endometriosis were significantly higher than in patients without endometriosis, and increased in accordance with the advancement of the clinical stage. Statistically appropriate cutoff values of CA 125 and CA 19-9 were calculated to be 20 IU/mL and 10 IU/mL, respectively. The sensitivity and specificity of CA 125 at this cutoff value for endometriosis were 72% and 71%, respectively. The sensitivity and specificity were 59% and 55% respectively in the case of CA 19-9. CONCLUSION: CA 125 is a useful marker for diagnosing and determining the severity of endometriosis. CA 19-9 shows limitation in diagnosing endometriosis, but is indeed a potential marker in predicting the severity of disease.