Severe labial adhesion causing lower genital tract obstruction and bilateral pyosalpinx in an adolescent girl / 대한산부인과학회지

Labial adhesions are extremely rare in adolescent and adult populations, because the etiology of this entity commonly relates to chronic vulvar inflammation or irritation, and is basically associated with low estrogen status. Although a few cases reported urinary retention resulting from severe labial adhesions, there is no report of labial adhesion that precipitates upper genital tract infection in prepubertal and postpubertal females. We present a rare case of severe labial adhesion and consequential lower genital tract obstruction that allegedly causing bilateral pyosalpinx in a 14-year-old adolescent girl who decisively denied sexual experience. The patient was successfully treated with surgical lysis of adhesion and administration of antibiotics.

Magnetic resonance imaging-guided focused ultrasound surgery for uterine fibroids: Initial experience in Korea / 대한산부인과학회지

OBJECTIVE: The purpose of this report is to review the safety and short-term efficacy of non-invasive magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) on uterine myomas in Korean women. METHODS: A total of 29 outpatient Korean women, whose mean age was 39.1+/-5.8 years, were treated using the MRgFUS system for their symptomatic uterine myomas. Patients??symptoms were recorded using a validated symptom-specific questionnaire on treatment day, and at follow-up visits, 3 and 6 months post treatment. Data on adverse events was recorded on each follow up period. RESULTS: Symptom improvement was experienced by 83% of the patients at the three months follow-up, and 90% of the patients reported on improved quality of life by the six months follow-up. There were no serious adverse events during the treatments or the follow-up period. CONCLUSION: MRgFUS appears to be a safe and effective treatment for symptoms relief of uterine fibroids. Additional reports on longer follow up should verify long-term durability.

The Associtation between Methylenetetrahydrofolate Reductase Gene Polymorphisms and a Risk of Spontaneously Aborted Embryos / 대한불임학회지

OBJECTIVE: This study was performed to understand the influence of the methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) genotypes on the spontaneously aborted embryos. METHODS: DNA was extracted from tissue samples of 95 spontaneously aborted embryos and 100 samples of normal children randomly and 449 samples of normal adults were selected as the controls. MTHFR genotypes were determined by a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. RESULTS: The aborted embryo group had higher frequency of MTHFR 677CC type (p=0.014) and lower 677CT type (p=0.063) than the controlled child group. The frequency of MTHFR 677CT type was drastically lower than that of controlled adult group (p=0.032). In the MTHFR C677T/A1298C combination, 677CC/1298AC genotype of the aborted embryo was significantly higher (p=0.034) than that of controlled child group, but it was not statistically significant in controlled adult group (p=0.063). CONCLUSION: MTHFR 677CC and MTHFR 677CC/1298AC genotypes may represent genetic markers for the risk of spontaneously aborted embryos at least in Koreans.

Uterine Artery Embolization for the Treatment of Symptomatic Fibroids

PURPOSE: The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. MATERIALS AND METHODS: Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710microgram). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. RESULTS: Symptom improvement for the menorrhagia (87.5%), dysmenorrhea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications included ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. CONCLUSION: UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

A Case of False Positive Amniotic Fluid Acetylcholinestserase in One Fetus of Twin Pregnancy conceived by Intracytoplasmic Sperm Injection and Zygote Intrafallopian Tube Transfer / 대한주산의학회잡지

Maternal serum alpha-fetoprotein(MSAFP) has been a world wide screening test for open neural the tube defect. But elevation of MSAFP is related to not only neural tube defect, but also incorrect gestational age, congenital anomalies such as congenital nephrosis, esophageal and intestinal obstruction, low birth weight, oligohydroamnios, fetal death and chromosomal anomalies. If MSAFP is elevated, gestational age, congenital anomalies such as neural tube defect, multiple pregnancy and fetal death must be evaluated by ultrasound. When the ultrasound is nondiagnostic, amniotic fluid AFP(AFAFP) levels are measured and if AFAFP is elevated, presence or absence of aetylchoineststarase(AChE) is determined to rule out the false positive of amniotic AFP. Amniotic AChE test yielded detection rate of open spina bifida of 99%, 98% for anecephaly and a false-positive rate of 0.34%. We report a case with elevated AFAFP and positive amniotic AChE result in one fetus of the twin pregnancy conceived by ICSI and ZIFT, but in which targeted ultrasound findings were normal, maintained the pregnancy to term and normal twin was delivered by elective cesarean section.

A Case of Kallmann Syndrome Conceived by Administration of Gonadotropin / 대한산부인과학회잡지

Pulsatile secretion of GnRH from the hypothalamus is a prerequisite for both the initiation and maintenance of the reproductive axis in humans. Failure of this episodic GnRH secretion results in the clinical syndrome of hypogonadotropic hypogonadism. Deficient GnRH secretion may occur in isolation (idiopathic hypogonadotropic hypogonadism: IHH), in association with anosmia (Kallmann syndrome), or as a result of a variety of structural and functional lesions of the hypothalamic pituitary axis. The familial occurrence of hypogonadotropic hypogonadism associated with anosmia, color blindness, synkinesia, and mental defect is the classic Kallmann syndrome. Affected individuals respond readily to pulsatile administration of exogenous GnRH, and clearly this is the most physiologic approach to ovulation induction. For women not seeking pregnancy, replacement therapy with exogenous estrogen and progestin is indicated. We have experienced a case of Kallmann syndrome which was conceived by administration of gonadotropin. So we report this case with a brief review of literatures.

A Case of Azoospermia Associated with Inversion of Chromosome 1 / 대한산부인과학회잡지

Chromosomally derived sterility has long been recognized. A review of the literature of somatic chromosome investigations in infertile males has shown that 13.7% of azoospermic males and 4.6% of oligozoospermic males have an abnormal karyotype. In the first group, sex chromosome abnormalities predominate (mainly 47,XXY), whereas in the latter, autosome anomalies (i.e. Robertsonian and reciprocal translocations) are the most frequent. A similar review on meiotic studies revealed that meiotic chromosome anomalies can explain male infertility in 4.3-40.4% of patients. Recently, fluorescent in-situ hybridization studies on spermatozoa from infertile men were published; it was suggested that both X-Y pairing and pairing of the autosomes were impaired, resulting in spermatogenic disruption. It is estimated that there are 2,000 genes that regulate spermatogenesis, most of these being present on the autosomes, but there are approximately 30 genes on the Y chromosome. In general, autosomal genes that regulate spermatogenesis are concerned with regulation of metabolic processes in other cells in the body as well as in the cells of spermatogenesis, whereas Y genes are not essential for vital functions related to reproduction. To be able to provide proper counseling for those couples whose male infertility can now be treated by intracytoplasmic sperm injection, it is suggested that clinical investigations should include mitotic and meiotic studies, an analysis of the chromosome content of individual spermatozoa and a DNA analysis of blood and spermatozoa to detect partially deleted Y chromosome material. We have experienced a case of azoospermia associated with inversion of chromosome 1. So we report this case with a brief review of literatures.

A Case of the Carrier of Reciprocal Translocation Which was Inherited from Patient with Recurrent Spontaneous Abortion / 대한산부인과학회잡지

A balanced translocation in a parent may produce unbalanced gametes leading to abortions or defective liveborn children, or interval infertility. It also may give rise to a balanced gamete resulting in a balanced carrier, or it may produce a cytogenetically normal gamete. The incidence of balanced chromosomal translocations in couples with multiple abortions was reported as 0% to 31%. This wide variation is related to the heterogeneous criteria used for patient selection. Because parents with balanced chromosomal rearrangements and history of only repeated abortions have a significant chance with each pregnancy of having a child with normal or balanced karyotype, the usual criteria for investigation include at least two abortions or reproductive losses. There is no evidence from several reported series that increasing the number of losses to three or more leads to any change in the yield of chromosomal rearrangements detected.

A Clinical Study of Unruptured Ectopic Pregnancies with the Treatment of Systemic or Local Methotrexate Injecton / 대한산부인과학회잡지

OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.

A Case of Hematometrocolpos due to Complete Septate Uterus and Obstructed Hemivagina associated with Ipsilateral Renal Agenesis / 대한산부인과학회잡지

We report a case of a 13-year-old girl who was noted to have combined malformation of complete septate uterus, obstructed hemivagina and ipsilateral renal agenesis with complaints of dysmenorrhea. Hematometrocolpos was developed in the result of retained menstrual blood since menarche. This rare congenital anomaly is supposed to be derived from disorders of mesonephric and M llerian developement in embryogenesis of female genitouinary tract. An accurate preoperative diagnosis of this syndrome is critical because of the difference in therapeutic strategy and prognosis. Simple and definite treatment of the condition is excision of the obstructed vaginal septum with prompt exit of retained blood. We present here a interesting case of M llerian anomaly in attempt to alert gynecologist to the possible occurrence of such a malformation with a brief review of concerned literatures.

Successful treatment with methotrexate injection on ectopic pregnancy embedded in the myometrium of a previous cesarean section scar / 대한산부인과학회잡지

Myometrial pregnancy developing in an previous cesarean section scar is the rarest of all ectopic pregnancy and provavly one of the most dangerous because of the risk of rupture and hemorrhage. For a young patient wanting to maintain her fertility, an earlier diagnosis and more conservative treatment are highly desirable. We present a case of an ectopic pregnancy embedded in the myometrium of a previous cesarean section scar in which the patient preserved her fertility through more noninvasive method, transvaginal ultrasound-guided Methotrexate injection.

Fertility outcome of Laparoscopic Tubal Reanastomosis / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.

Antenatal Diagnosis of Chorioangioma of the Placenta / 대한산부인과학회잡지

Since the placenta is an organ composed of blood vessels, it is not surprising that its primary neoplasm would be a vascular tumor. Placental tumors, primary or secondary, have been known to interfere with placental function. Chorioangioma(primary tumor of the placenta), which is the most common of them, occurs with an incidence for clinically significant ranges from 1~2.8:10000 births. These tumors are benign and are not usually associated with clinical sequelae unless they are larger than 5cm in long diameter. About one third of the large chorioangiomas may be associated with the maternal and fetal complications. For diagnosis of these lesions, the ultrasonography was used. If the chorioangioma is suspected, color doppler study is informative to confirm the presence of the vascular channels. We reviewed ultrasonograms and clinical records of seven patients who had been diagnosed as placental chrioangioma. The appropriate diagnostic tests and treatment can then be initiated in order to prolong gestation and decrease fetal mortality and morbidity.

Comparison of Diagnostic Accuracy in Uterine Pathology among HSG, Hysteroscopy, and Sono-Hysterography / 대한산부인과학회잡지

Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.